Oral Answers to Questions

HEALTH

The Secretary of State was asked—

Co-payments

John Baron: What guidance his Department has issued to NHS organisations on co-payments.

Alan Johnson: Guidance has existed for more than 20 years. I have today asked Professor Mike Richards—the national clinical director for cancer—to review policy relating to patients who choose to pay privately for drugs not funded on the NHS. Terms of reference have been placed in the Library.

John Baron: I very much welcome the Secretary of State's announcement, as will many campaigners up and down the country and in the House. The ban on co-payments was cruel, because, as we know, it took NHS care away from patients who were dying, and it was illogical because co-payments existed in other parts of the NHS. Will the Secretary of State assure the House that the review will not have the effect, however inadvertently, of kicking the issue into the long grass, because, as the case of Linda O'Boyle proved, patients want and need the change in the policy now, not in a year's time?

Alan Johnson: The hon. Gentleman has represented his constituent, Mrs. Linda O'Boyle, vociferously in the House and, indeed, on a non-party political basis, and many other Members on both sides of the House have raised the issue. It is time that someone with the expertise of Professor Mike Richards looked at the issue. It will hardly go into the long grass; I want Mike Richards to report in October. When the hon. Gentleman has had a chance to read the terms of reference, he will see that I am asking Mike Richards to look at very complex issues. I am not saying that he should come down one way or the other; I am saying that he needs to review the issue, given the need, which hon. Members on both sides of the House understand, to protect the principles of the NHS as a service free at the point of need and the very understandable concerns of Mrs. O'Boyle's family and many others involved to find out whether we can ensure that we get guidance that is up to date and related to what is happening now in the NHS, that is fair to everyone and that resolves some of the problems that the hon. Gentleman and others have raised.

Frank Field: May I welcome the Secretary of State's statement? Many Labour Members welcome it, as well as Opposition Members. I am grateful for his emphasising that this is not a new policy; it is one that the Government inherited. May I add that, by in a sense time-limiting the review, he will increase support in the country for the outcome of the review, whatever it is?

Alan Johnson: I thank my right hon. Friend. He, too, has raised the issue in various debates in the House. The guidance goes back at least to 1986 and probably before then. I have no need to ask Professor Mike Richards—he will do this anyway—to talk to Members, such as the hon. Member for Billericay (Mr. Baron), my right hon. Friend and others who want to raise specific issues. That can be done in the time scale that has been set—certainly, Professor Richards thinks that it can—and, as I say, that will ensure that I do not stand at the Dispatch Box merely repeating guidance that has existed for 20 or 30 years. We can determine what we need to do now in the NHS to resolve some of these very difficult and complex problems.

Richard Taylor: I also welcome the review that the Secretary of State has announced. Will he ensure that, in the deliberation, the needs of the silent voices—those who cannot afford the extra payments—are not forgotten?

Alan Johnson: The hon. Gentleman raises a very important issue. The scenario that many in the NHS feared, which has led to the guidance over the years, is that a patient in the first bed on a ward would be treated completely differently from the one in the second bed, because of their ability to pay. That is not the argument that has been raised by hon. Members in the House. I understand very clearly the fundamental points that are being made, particularly about Mrs. O'Boyle, who did not know that there was an obligation to pay for treatment until she had received it. But the hon. Gentleman, from his experience in the NHS, raises the fundamental, key issue, which I hope he will accept is very clearly set out in the terms of reference.

Clive Efford: Will the Secretary of State give an assurance that the review will not result in a lottery system in the NHS, whereby people who can afford to pay can buy better treatment than people who cannot afford to do so? Most hon. Members on both sides of the House would be concerned if that inequality were introduced into the NHS, because it could become the thin end of the wedge for things such as top-up payments for other treatments. Will he assure us that the review will not open up that avenue?

Alan Johnson: I can give my hon. Friend that assurance. I shall quote the terms of reference, which state that the review should take into account
	"the importance of enabling patients to have choice and personal control over their healthcare; and the need to uphold the founding principle of the NHS that treatment is based on clinical need not ability to pay, and to ensure that NHS services are fair to both patients and taxpayers".
	My hon. Friend should be reassured that we are reviewing how the system works in the 21st-century NHS, and that the outcome is not predetermined. Professor Mike Richards is a respected clinician: he led the development of the cancer plan and cancer strategy, and until recently he was chairman of the National Cancer Research Institute. All the cases that I have examined, including Mrs. O'Boyle's, relate to cancer—mainly bowel cancer and kidney cancer. Professor Richards has spent his whole life in the NHS, so he is the perfect person to review the situation very quickly. The report will be published, so hon. Members will have the chance to see the results.

David Taylor: Desperately ill patients and their families are often vulnerable to the false hope provided by miracle drugs, which are sometimes touted in the media. What consumer advice—it is almost consumer protection—will be given to those people so that they do not waste their time and money or expend their hope on what are cul-de-sacs so far as treatment is concerned?

Alan Johnson: My hon. Friend raises another dimension to the issue. Professor Richards led on the cancer strategy, which was published in December and pointed out the need to get cancer drugs through the process much more quickly. Consumers who are considering drugs that are available on the internet should, first, take the advice of their clinician; secondly, check whether the drug is licensed; and, thirdly, if it is licensed, ensure that they know where it sits in relation to the NICE process. We can speed up the NICE process, and we will comment on that in the next-stage review, which will be published shortly. The internet contains a range of drugs, some of which are licensed and some of which are not. We must be vociferous in ensuring that consumers get the right advice, and we must do what we can to ensure the proper regulation of such drugs.

Andrew Lansley: I am sure that the House is grateful to the Secretary of State for initiating the review. The Secretary of State will also appreciate that we have not had access to the terms of reference. It would be helpful if the Secretary of State, taking account of the case made by my hon. Friend the Member for Billericay (Mr. Baron) on behalf of Mrs. O'Boyle and her family, were to agree that we need to examine two principles. First, if patients access private treatment beyond the boundaries of NHS care, it should not mean that they lose their entitlement to NHS care. Secondly, NHS care itself should continue to be both comprehensive and free based on need, not ability to pay. I gather from the terms of reference that the Secretary of State has included the latter principle, but has he included the former?

Alan Johnson: I appreciate that the hon. Gentleman has not had a chance to see the review's terms of reference, but that sounded like an attempt to pre-empt the outcome. We are clear that someone who has had private treatment can return to the NHS for treatment, and we are also clear that people who have had NHS treatment are perfectly entitled to obtain private treatment. The ambiguity occurs over the term "an episode of care" and whether someone can buy a drug that is not available on the NHS and ask the NHS to pay for its administration as part of their treatment. I want Professor Richards to examine that area, and I do not want to predetermine the review. Professor Richards is well aware of the problems experienced by Mrs. O'Boyle and others, because he deals with such issues all the time. When the hon. Gentleman sees the terms of reference—I will not take up the House's time by reading them all out, because there are quite a few words—I hope that he will be assured that that point has been addressed. If not, the issue is not party political, and he is welcome to come and see me—indeed, I am sure that Mike Richards would be keen to talk to him.

Andrew Lansley: I look forward to discussing the matter with Mike Richards. The Secretary of State will appreciate why I mention "comprehensive care". The review particularly relates to many of the new cancer drugs. Mike Richards and the NHS also need to address how patients who rely on the NHS for their treatment can be sure that they will get comprehensive treatment. For example, I have a list of 20 European countries where Erbitux, the brand name for Cetuximab, which was privately provided for Mrs. O'Boyle, is routinely made available for patients with colorectal cancer. In the NHS, Mrs. O'Boyle was told that that drug was not available. Surely we must address that question, too.

Alan Johnson: I do not believe that that is about the terms of reference. The issue is how we deal with the NICE process. Cetuximab was a specific issue and it had not been through the NICE process. The PCT decided that the circumstances were not exceptional and, therefore, the treatment was not given. There is a whole different dimension to the issue under discussion. The fundamental problems that Professor Richards will look at are confined not to cancer drugs but to drugs per se. There may be many other issues and unintended consequences, because we have been concentrating so closely on the understandably controversial issues surrounding Mrs. O'Boyle and others. But Professor Richards's remit will be to look right across the range. The worst thing that could happen to the review would be if he were to concentrate on one particular area and on a few particular drugs, and then miss the fact that unintended consequences apply to other illnesses and to other drugs.

HIV Infection

Patrick Hall: How many newly acquired HIV infections were recorded in 2007.

Dawn Primarolo: Data on newly acquired HIV infections are not available, but an estimated 5,817 people were reported as newly diagnosed with HIV infection in 2007, compared with 6,769 in 2006. The figures include people with long-standing infections, including many who were infected outside England but who were subsequently diagnosed in this country.

Patrick Hall: I thank my right hon. Friend for her answer. She will know that there is a serious problem not only with the overall numbers, which, although coming down, were recently still up on the 1997 figure of, I think, 3,000. She will also know about the problem of late diagnosis—people being diagnosed six or seven years after becoming infected, by which time they have become highly infectious and less likely to respond to treatment. She will be aware that London's strategic health authority has highlighted that big problem and is trying to address it with a target to halve the number of people who are diagnosed late. Will she seek to use her influence to spread that target and practice throughout all health authorities in the country?

Dawn Primarolo: My hon. Friend raises a very important point. He will know that the prevalence of HIV in England is one of the lowest in Europe—comparable to that in Sweden, the Netherlands and Denmark. Nevertheless, he is quite correct: about 31 per cent. of those who are infected are unaware of the fact. The steps that the Department has been taking have been, first, to focus on publicising the importance of early testing and on providing extra resources; secondly, to improve timely access to NHS testing, particularly in a variety of settings, not just in genito-urinary medicine clinics; thirdly, to look very specifically at where the highest risks are and to ensure that information and support are provided to those groups to encourage them to come forward for testing; and, finally, to undertake work with those in the voluntary and third sectors, as well as with local health authorities, to try to remove the stigma and the perceived discrimination that many people fear in order to encourage them to come forward.

David Heath: Has the right hon. Lady had any recent discussions with her colleagues in the Department for Work and Pensions about the growing concerns regarding medical assessments of people with HIV infections, in respect of disability allowances and of fitness for work? It is a growing concern, and it would be very useful if she were to have appropriate discussions with the DWP to ensure that it applies the right tests.

Dawn Primarolo: I have not had any discussions recently about that point, but if the hon. Gentleman has specific issues and experience in his constituency I would be very happy if he sent them to me, because clearly we must ensure that medical assessments are conducted correctly, particularly with regard to that very vulnerable group.

Neil Gerrard: I am sure that my right hon. Friend recognises the risks to public health from the greater number of new infections and from people who are undiagnosed. Given that, will she look again at including HIV in the list of infections that are exempt from NHS charges? We must have a balance between the public health risks and the financial costs, recognising that the risks outweigh the costs.

Dawn Primarolo: All people who are ordinarily resident in England are entitled to free national health service treatment, including for HIV. My hon. Friend will be aware that that is qualified by exempting categories of individuals from charges under the National Health Service (Charges to Overseas Visitors) Regulations 1989, as amended. He will also be aware that asylum seekers are exempt from charges for all hospital treatment, including for HIV, and will remain exempt for courses of treatment that continue if and when their applications for asylum are rejected. All the points with regard to the threat to public health that he correctly identifies are addressed in the strategies that we use.

Mark Pritchard: The Minister will know even from the Government's own data that many of the at-risk people to whom she referred are from sub-Saharan Africa. What consideration have the Government given to selected pre-screening of people who apply to move to the United Kingdom through work visas or student visas, or, indeed, as asylum seekers?

Dawn Primarolo: The hon. Gentleman will know that the Government have announced that they are investing an extra £2 million, in addition to the moneys already committed to prevention work, to look specifically at groups of highest risk, including gay men and people from African communities. Working through the African communities and the African HIV project, we are addressing particularly the issues that the hon. Gentleman mentions. It is important that people come forward for early testing. It is not necessary to have compulsory testing. We are seeing that testing through the various clinics and measures has increased dramatically—in some cases, by up to 85 per cent.

David Borrow: Does my right hon. Friend agree that there is a danger that as more and more people are living and working with HIV/AIDS, the perception of the disease as being life-threatening recedes, and that any prevention programme therefore needs to recognise that change in perception and to focus very much on the fact that being able to take drugs and in most cases live a long and productive life is not a reason to assume that one is not at risk?

Dawn Primarolo: My hon. Friend is absolutely right. With the development of therapies and treatments, it is particularly important that people understand that HIV is still a deadly disease. We particularly need to understand—the Department is taking this forward—which groups in the community may be less aware of the risk, or have a belief that they can live with it, and to target additional information and support to them to encourage them, first, to come forward for testing, and, secondly, to desist from activities that increase their likelihood of HIV infection.

Liver Disease

Brian Iddon: What steps he is taking to tackle liver disease.

Ann Keen: We are concerned about the increasing incidence of and mortality from liver disease. I congratulate my hon. Friend on his work in the all-party group on hepatology and on the many Adjournment debates that he has introduced on this issue. We are already taking action on a number of fronts to combat its primary causes—alcohol misuse, which is the most common, viral hepatitis and obesity. We accept that there is strong support for developing a national plan for liver disease.

Brian Iddon: Unlike deaths from other major diseases, which are going down significantly, deaths from liver disease caused by viral infections, obesity and excessive consumption of alcohol are, tragically, rising significantly. What more can my hon. Friend do to reverse that trend, and when will we see a national service framework established in the field of hepatology?

Ann Keen: We have engaged with a wide range of stakeholders in order to build a consensus on the issues that my hon. Friend has raised and on what we might do about them. We shall decide on our next steps in the light of that and of preliminary work on the evidence. Much of the evidence is being taken by Professor Ian Gilmore and Professor Eileen Kaner of Newcastle university. Problematic drinking is a key cause of liver disease. In our national alcohol strategy, we support a comprehensive approach, across and beyond Government, to address the consequences of harm caused by alcohol. We have a range of measures in place to tackle hepatitis B and C, such as a national hepatitis C action plan and awareness campaign. Our expert committee, the Joint Committee on Vaccination and Immunisation, is reviewing the national hepatitis B immunisation programme. Tomorrow, I shall meet some officers of the all-party group, and I hope to take the process forward as soon as possible.

Philip Hollobone: Does the Under-Secretary share my concern at the growth in the instance of liver disease among younger people through the misuse of alcohol? What steps is she taking in conjunction with other Departments to target that age group to prevent the problem of binge drinking?

Ann Keen: Our national alcohol strategy has been rolled out along with, today, a Home Office initiative on the very subject that the hon. Gentleman rightly raises. Education on liver disease and its serious consequences, which sometimes do not come to light for many years to come, is difficult to get across to young people because they live for today, and serious consequences for the liver may not become apparent for 10, 15 or even 20 years. Much more can be done and I am happy to work with the hon. Gentleman on any initiative he wants to bring to me.

Ann Cryer: Has my hon. Friend considered a requirement for a Government health warning on all tins and bottles of alcoholic beverages, similar to the warnings that we have on packets of cigarettes? A number of countries throughout the world use them.

Ann Keen: I am informed by the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), that there is a voluntary system in place at the moment, but we can always look to do more because the consequences for young people are so serious and because the rate of deaths from liver disease in this country is rising.

John Bercow: What discussions has the Under-Secretary had with colleagues in the Department for Children, Schools and Families and the Ministry of Justice to ensure that there is some sort of co-ordinated action whereby the contents of the strategy can be rolled out in prisons in due course, and within young offender institutions in particular? Action is urgently needed there.

Ann Keen: The hon. Gentleman is right. The Department for Children, Schools and Families works closely with the Department of Health. Secretaries of State from both Departments meet regularly to consider the children's plan and the health plan. It is not only alcohol that causes liver disease and hepatitis, but obesity, too. The obesity plan for young people is currently in place.

GP Surgeries

Paddy Tipping: What recent steps he has taken to extend the hours during which GP surgeries are open for patients.

Ben Bradshaw: In March, we agreed changes with the British Medical Association to reward practices that extend their opening to provide weekend or evening appointments. I am pleased to tell the House that 21 primary care trust areas have already achieved our aim that at least 50 per cent. of surgeries should offer extended hours.

Paddy Tipping: But would not the creation of 152 GP-led surgeries, open from 8 am until 8 pm, seven days a week, provide greater choice and better health opportunities for patients— [ Interruption. ]—rather than leading to closures in Nottinghamshire, or anywhere else in the country, as the British Medical Association suggests?

Ben Bradshaw: I agree with my hon. Friend, who makes an important point. I heard some Opposition Members shout, "Not in rural areas." Yet Cornwall is one of the counties that has already achieved the 50 per cent. target—indeed, it has exceeded 90 per cent. However, some GPs may not want to open in the evenings or at weekends, so we believe that it is perfectly proper that patients in those areas are not denied the ability to remain registered with their GP, if they wish, and to see a GP in the evening or at weekends. They will value that greatly and not understand the Conservatives' promise to reverse the policy.

Nicholas Winterton: I strongly support the idea that GPs' surgeries should open for longer. In the main, GPs are popular with their patients, are trusted and know the details of the conditions of those on their panel. However, I am reserved about the Government's proposal to open polyclinics, which I believe would be an expensive duplication of GPs' services and undermine the position of GP surgeries. Will not the Government reconsider their proposal and perhaps try to work through GPs to extend services, so that the services that people want are available in the evening and at weekends?

Ben Bradshaw: The hon. Gentleman is rarely known to be reserved in the House, but I welcome his support for our extended hours drive and invite him to discuss it with his Front Benchers. As I said, they promised to reverse the policy and give the BMA a veto over extended hours. The last time we had an exchange on the subject, the hon. Gentleman highlighted the success and popularity of a GP-led health centre that provides an excellent service in his constituency. We are not imposing anything on any primary care trust, but simply saying that, in every PCT area, there should be a GP-led health centre, such as the one of which the hon. Gentleman is fond in his constituency, for patients whose surgeries are not open in the evenings or at weekends to give them the choice.

Ken Purchase: In the city of Wolverhampton, some GPs have tried extended opening and found little demand, whereas another surgery is opening on Saturday mornings to trial the policy. Is there any quantitative evidence from the west midlands—or, indeed, the city of Wolverhampton—that might give us a better steer on potential demand from patients for the extended hours service?

Ben Bradshaw: Every survey that we conduct of what the public think is the most important improvement that we can make to build on the improvements that we have already made in the health service shows that people want to be able to see a GP at a more convenient time to the patient—at weekends or in the evenings. My hon. Friend's local primary care trust may not yet have hit the 50 per cent. target, but neighbouring Heart of Birmingham PCT has, with 75 per cent. of GP practices already offering extended hours. It is popular, the public tell us that they like it, and the GPs, once they start doing it, also find it popular.

Anne McIntosh: Does the Minister agree that it is not so much the hours that GPs are available that are important, but the services that each GP practice offers? Is he aware that the White Paper on pharmacy proposed taking away the ability of GP practices in market towns such as Thirsk to dispense? That will reduce the services that they can offer. There is no point in the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) shaking her head. I met representatives of GP practices and I also declare an interest as a GP's daughter and a GP's sister. We want to keep dispensing services in rural practices.

Ben Bradshaw: My right hon. Friend was shaking her head because she wrote the pharmacy White Paper and she knows that it does not do what the hon. Lady suggests. The hon. Lady also knows that we are consulting on all aspects of the White Paper, and I invite her to make a formal representation as part of the consultation.

Charlotte Atkins: Does the Minister know that, in areas such as Leek, which is a market town, GPs already successfully offer an out-of-hours service from 10 am until 2 pm, on Saturdays, Sundays and bank holidays? Is not it time that other GPs followed that good practice and recognised that patients want not only high quality but more accessible services to fit in with their lifestyles?

Ben Bradshaw: I agree with my hon. Friend, who has given a good example of what happens in an area when one or two GPs start offering the service to patients: other GPs quickly follow suit because they discover that it is popular. It is extraordinary that some hon. Members still believe that, although it is fine for people in some parts of the country to be able to see a GP in the evenings and at weekends, that service should not be available to everybody. Labour Members believe that it should be.

Mark Simmonds: It seems extraordinary that the Minister is claiming credit for the Government reinstating a service that they removed three or four years ago. I want to press him further on the point that my hon. Friend the Member for Vale of York (Miss McIntosh) made. She was absolutely right to say that access to GPs and primary care is about more than just opening hours. Will the Minister acknowledge that the proposals in the pharmacy White Paper that potentially remove the right of GP practices to dispense are causing immense concern both to service providers and, more importantly, to their patients? In consultation with the Minister responsible—the right hon. Member for Bristol, South (Dawn Primarolo), who is whispering in his ear—will he confirm that there will be no changes to the control of entry regime without a full, published, comprehensive and genuine consultation that takes into account the needs of communities that use GP dispensing services and pays particular regard to the proposed changes in the White Paper to the imposed distance criteria?

Ben Bradshaw: The hon. Gentleman is doing the same thing as a lot of his hon. Friends—confusing out-of-hours services with extended hours. I am pleased if he is reversing the Conservatives' policy and saying that they will not reverse the provision for extended hours, because I suspect that he will find shortly that extended hours will be very popular with the public when they begin to access to them. I suspect that the policy is not one that the Conservatives will abandon as quickly as they have most of their other policies.
	On the pharmacy White Paper, I have already said in answer to the hon. Member for Vale of York (Miss McIntosh) that there will be a consultation. Our view is that the hon. Gentleman is wrong in his interpretation of the White Paper's impact, but he is welcome to make his views felt during the consultation.

Standish Hospital

David Drew: What progress is being made on proposals to re-use the Standish hospital site.

Ben Bradshaw: The national health service locally in my hon. Friend's constituency is continuing to consider the future of the Standish hospital site and is exploring the potential to develop services that would benefit the people of Gloucestershire. We expect the decision to be made shortly.

David Drew: I thank my hon. Friend for that and commend him on visiting the site. He knows what a beautiful site it is and what potential it has. It would be good to hear that progress is being made. Indeed, I gather from what is happening that this innovative scheme between the learning and disabilities trust, the primary care trust and the voluntary sector will become a reality, so anything that he can do to help it along will be gratefully welcomed in the area.

Ben Bradshaw: I am grateful to my hon. Friend for that and for the invitation to visit his constituency, which I recall I did on an extremely wet spring day. My understanding is that the main obstacle to progress is the listing of part of a building on the site. May I suggest to my hon. Friend that he make representations to my right hon. Friend the Minister of State, Department for Culture, Media and Sport, if he has not already done so, to ensure that she is well aware of his views on the merits or otherwise of listing that building?

Infertility Services

Sally Keeble: What steps he is taking to improve access to NHS infertility services.

Dawn Primarolo: Two main issues are currently being addressed. First, the Government conducted a survey of in vitro fertilisation provision in all primary care trusts. A copy of that survey has been placed in the Library today. That is part of the Department's regular monitoring of IVF provision and tracking of progress towards the National Institute for Health and Clinical Excellence's recommendations. Secondly, the Infertility Network UK, which is funded by the Department for that activity, is identifying and establishing standard access criteria to fertility treatment.

Sally Keeble: I very much welcome that statement. As my right hon. Friend knows, next month is the 30th anniversary of the birth of the first test-tube baby. Will she consider marking that by ensuring an end to the postcode lottery that still exists in access to treatment and by increasing entitlement to three rounds of treatment on the NHS, as recommended by NICE?

Dawn Primarolo: As my hon. Friend is well aware—she has campaigned extensively in her constituency and in the House—the local NHS takes decisions about the treatment that it provides for its local communities and identifies priorities. In my view, we will reach the NICE recommendations when the local NHS acknowledges the fact that one in seven adults experiences difficulties with fertility, and makes the provision of fertility treatment services a higher priority. Members of Parliament have an important role in discussions with their PCTs, which do a difficult job in trying to reflect local criteria and priorities.

Peter Bone: The Minister will know that IVF treatment was suspended in Northamptonshire because of lack of money. Northamptonshire is the worst funded primary care trust in the whole country in respect of the national capitation formula, so the suggestion that it is up to local PCTs to decide on IVF treatment is a little unfair when the problem is the lack of Government money going to Northamptonshire.

Dawn Primarolo: That is simply not true. I know that the hon. Gentleman has made representations and that he is very clear in making them for his constituents, but he will also know that his PCT is within the 3.5 band in terms of funding. I have to tell him, in view of the different number of cycles offered, that one of the big debates that remains to be concluded across the country is whether the provision of IVF treatment is a priority for local health services that is equal to other priorities. That matter can be settled locally when it is made clear that the provision of IVF services is important. The hon. Gentleman's PCT provides other services that it also believes are important, so we need to ensure that equal priority is given.

Cord Blood Programme

Ann Winterton: What plans he has to establish a national cord blood programme.

Dawn Primarolo: There is already a national cord blood programme in place. The NHS cord blood bank, supported by NHS Blood and Transplant and funded by the Department of Health, collects cord blood from four centres. All the cord blood units stored in the NHS cord blood bank are available to NHS patients across the country.

Ann Winterton: Is the Minister aware that the Anthony Nolan Trust estimates that tens of thousands of pints of cord blood, which could be used for transplantation and research purposes, are discarded every year in the UK? Will the Minister support the charity's proposed national cord blood bank to ensure that units donated altruistically by mothers are used to drive forward medical research rather than be discarded, thereby totally wasting this valuable resource?

Dawn Primarolo: I had a meeting with representatives of the Anthony Nolan Trust recently and I should say to the hon. Lady that the NHS has access through the international bone marrow registry and others to about 10 million samples, and that 72 per cent. of the matches in cord blood in the UK are provided internationally. There are two separate issues here: the first is treatment now and the second is research. The Anthony Nolan Trust is looking particularly into the issue of treatment now. The NHS cord blood bank is currently undertaking a review, which will report to me later this year about how to ensure a greater percentage of matches. We have already put in extra money, particularly for collection in respect of black, minority and ethnic communities. Over and above that, the Anthony Nolan Trust is looking into the development of its services, and I have said that it is crucial that developments at both the NHS blood bank and the Anthony Nolan Trust take place in partnership to ensure that we maximise the benefits for UK patients. That is what we intend to do.

Cardio-vascular Incidents

Andrew Stunell: When he was informed of reported increases in the occurrence of cardio-vascular incidents linked to Vioxx (rofecoxib).

Ivan Lewis: The cardio-vascular safety of Vioxx was intensively monitored and investigated by the Medicines and Healthcare products Regulatory Agency with regular, independent advice from the Committee on Safety of Medicines. That happened since a possible increased cardio-vascular risk was noted in the VIGOR study in 2000, shortly after Vioxx was marketed. The first definitive evidence of increased cardio-vascular risk arose in a long-term placebo-controlled clinical trial, the APPROVe study, in September 2004, at which time the manufacturer withdrew Vioxx from the market.

Andrew Stunell: May I remind the Minister that many hundreds of NHS patients, such as my constituent, Mr. Lowe, who were prescribed Vioxx have subsequently suffered serious side-effects—in Mr. Lowe's case, a heart attack? What steps will the Minister take to get the manufacturer of Vioxx—Merck Ltd. from the United States—to face up to its liabilities to patients here in the UK in the way that it has been forced to do in the United States of America?

Ivan Lewis: The hon. Gentleman raises an important point. A number of patients within the NHS feel that their lives have been adversely affected very seriously as a consequence of taking the drug. He is right to say that compensation is being paid by the manufacturer in the United States of America. We need to look at the pressure we can apply to that manufacturer in terms of its responsibilities to people in the United Kingdom who have been affected.

Norman Lamb: May I reinforce the intense sense of anger and injustice felt by the victims of Vioxx in the UK, many of whom attended a lobby of Parliament today? They are in exactly the same position as people in the United States who have benefited from a $4.8 billion settlement. Does the Minister agree that it is an outrage that this drug company is discriminating against UK victims? Will he join me in calling on it to rethink its position and meet an all-party delegation of MPs to see what further pressure, as he says, should be put on the company?

Ivan Lewis: Again, I agree with the hon. Gentleman. I think that I can commit to two things. First, of course I will meet an all-party group of MPs to focus on this particular issue and consider what we might do. Secondly, I will certainly be making sure that the Department contacts the manufacturer to ensure that it fulfils its responsibilities to people who have been affected in the UK in the same way as it is now compensating people in the United States.

Topical Questions

Lynne Jones: If he will make a statement on his departmental responsibilities.

Alan Johnson: The responsibilities of my Department embrace the whole range of NHS social care, mental health and public health service delivery, all of which are of equal importance.

Lynne Jones: My supplementary question is on mental health advocacy. What measures is my right hon. Friend putting in place to ensure that there will be adequate resources in April 2009 when measures in the Mental Health Act 2007 on independent advocacy are implemented? How will he ensure that non-statutory services will be safeguarded and improved?

Alan Johnson: Negotiations on the comprehensive spending review included the introduction of those services in April 2009. The funding is already available for that. Non-statutory funding—assistance of the voluntary sector and so on—is crucial to the success of this project. I give my hon. Friend the assurances that I believe she is seeking.

Michael Penning: On the subject of dentistry, in February 2008, the Secretary of State said:
	"Access to NHS dentistry is getting better all the time."—[ Official Report, 5 February 2008; Vol. 471, c. 772.]
	I do not think my constituents, constituents around the country or dentists are quite certain what figures the Secretary of State was referring to. Recent figures since his contribution in 2008 show that nearly 1 million British members of the public no longer have access to NHS dentistry. Will he now retract his comments and scrap this ludicrous contract?

Alan Johnson: No, I will not.
	"It's getting better all the time",
	to quote a line from a track on "Sgt. Pepper". It is getting better in dentistry because the original contract, which the hon. Gentleman seems to want us to reintroduce, was wrong in every respect.

Michael Penning: No, we do not.

Alan Johnson: But we are being asked to withdraw the current contract. It replaced the contract that encouraged drill and fill. It meant that when dentists left the local vicinity, the money went with them. Of course, there was a period when dentists did not sign up to the new contract. Gradually, they are coming back and gradually we are getting to a situation in which dentistry is provided not just on the basis of drill and fill, but on a preventive basis, with a much simpler structure and much better access. The money that we are putting into dentistry this year, next year and the year after has gone up, and primary care trusts are commissioning more dental practices as a result.

Claire Curtis-Thomas: As my right hon. Friend will know, back in 1997, the construction industry was on the point of collapse. I am proud of the health service's commitments to new hospitals and clinics, which have revitalised the industry, but I want to ensure that its significant investment leads to training opportunities for young people as part of their apprenticeship programmes. What is my right hon. Friend doing to ensure that those public sector funds are spent on delivering better skills and better-qualified young people?

Alan Johnson: My hon. Friend has been a champion of apprenticeships. I think she will accept that what the Department is doing is exemplary in Whitehall terms. Indeed, I hope she will accept that we are "Top of the Pops" in terms of the number of apprentices we are recruiting.
	As for what we are doing in the country more generally, my right hon. Friend the Secretary of State for Innovation, Universities and Skills is running an integrated project to establish how we can use the huge public sector investments that we are making in, for instance, hospital-building programmes to ensure that apprenticeships are provided in the construction industry, and also in education, so that we do not waste the valuable opportunity provided by our capital investment to increase the number of apprentices again. It needs to be raised to the level suggested in the Leitch review by 2015.

Mark Pritchard: Would the Minister of State like to have another go at answering my earlier question about HIV/AIDS? Given the increasing number of cases of HIV/AIDS and, indeed, TB in this country, many of them brought in by people from sub-Saharan Africa, will she tell us whether she believes that selective pre-screening of those people before they enter the United Kingdom, not while they are here, is a good idea for Britain?

Dawn Primarolo: I believe that I have already answered the question, but I will answer it again. No, the Government do not consider pre-screening to be necessary. Our policy is to encourage the highest-risk groups to come forward voluntarily for screening. The group that the hon. Gentleman has identified is not the highest-risk group, but it is one of the groups that we are addressing.

Tom Clarke: The report "Aiming high for disabled children: better support for families" led to additional resources. Can my hon. Friend the Under-Secretary of State assure me that they are being used to enable the services identified in the report to benefit disabled children and their families, and for no other purpose?

Ivan Lewis: I pay tribute to my right hon. Friend for the work that he did in the House in championing the needs of disabled children and their families, as a result of which we are investing an unprecedented amount to support those families—and so we should.
	The money from the Department for Children, Schools and Families is ring-fenced, and amounts to £370 million over three years. In the autumn of this year, the Department of Health will announce the overall sum that we will invest in child health over the next three years. It will include a specific figure to be put into primary care trust baselines to increase support for children with special needs and provide short breaks and support for children with palliative care needs. It is crucial, in all parts of the United Kingdom, for us to prioritise the needs of disabled children and their families, and to ensure that the money allocated for the purpose is spent on improving their quality of life.

Anne Milton: Although the number of people admitted to hospital suffering from under-nutrition has increased by 85 per cent. since 1997, I understand that the Minister is scrapping the Nutrition Action Plan Delivery Board that he established last year. What reassurance can he give us that he takes malnutrition in the elderly seriously?

Ivan Lewis: As I have only just established the board, I am hardly likely to be scrapping it. The hon. Lady's information is completely untrue.
	The nutrition action plan is overseen by the director general of Age Concern. It has independence, and is being overseen by someone who has passionately championed the importance of nutrition, particularly in relation to older people. What we have said, as the hon. Lady knows full well, is that the board will do its work for 12 months and then we will review where it goes from there. There has been absolutely no suggestion that we intend to scrap it.

Phyllis Starkey: A constituent of mine with cystitis has received treatment for acute episodes at the nurse-led walk-in centre in Milton Keynes, but she has been unable to get an appointment with her GP in order to be referred to a consultant because she is a shift worker and because of the booking system at the surgery. Will the Minister point out to the British Medical Association and the Opposition that this is exactly the sort of problem that could be addressed by the new seven-day surgery proposed by the PCT in Milton Keynes?

Alan Johnson: We will have the perfect opportunity to do that in about five minutes' time.

Desmond Swayne: If GP-led health centres are in the interests of patients, does not the Secretary of State believe that primary care trusts will procure them anyway? Why is he running the show like a command economy and requiring 121 PCTs outside London to procure them?

Alan Johnson: Because, No. 1, we believe that we ought to enhance capacity in primary care; No. 2, we do not believe that PCTs should be paying for extra facilities from money we have already allocated—we will provide that from the centre; No. 3, we think patients such as the constituent of my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) should be able to access a GP surgery from 8 am to 8 pm, seven days a week, 365 days a year; and, No. 4, we believe that people who cannot get to their GP because, for example, they work in the centre of town or in another town should be able to access primary care. For all those reasons, it is extraordinary that Opposition Members, including the Parliamentary Private Secretary to the Leader of the Opposition, oppose this extra investment in primary care. They will live to rue the day.

Tom Brake: I met Dr. Goel at his Carshalton fields surgery a couple of weeks ago and he presented me with a petition with 570 signatures from patients who are very worried about the future of their local family GP practice. Can the Secretary of State confirm that that practice will not be forced to merge with a polytechnic—or a polyclinic, rather—at some point in the future?

Alan Johnson: It certainly will not be forced to merge with a polytechnic; I can give the hon. Gentleman that assurance very firmly. Our proposals are for additional GP-led health centres. The name should give the Opposition a bit of a clue as to who will lead these health centres. They will be GP-led, and there is no intention whatever of removing existing services.

Ann Cryer: Does my hon. Friend have a view on the Council for Healthcare Regulatory Excellence report on the Nursing and Midwifery Council?

Ben Bradshaw: We welcome the report and accept its recommendations. It makes some very serious criticisms of the functioning and leadership of the NMC, saying it has failed to carry out its statutory duties to the standard the public have the right to expect and it has lost the confidence of its stakeholders. It is our view and that of the CHRE, the trade unions and other stakeholders that it would be in the best interests of the NMC and the individuals involved if all three senior figures stepped down from their current positions. We welcome the leadership shown by the president and chief executive today in indicating their intentions to resign.

Bob Russell: I am sure that the Secretary of State will agree that many of our hospital accident and emergency departments are full of people whose ailments would be better treated elsewhere. On the basis that all of us are in favour of preventive health measures, will the Secretary of State discuss with the Secretary of State for Children, Schools and Families the possibility of introducing first-aid training as part of the school curriculum, in accordance with my excellent ten-minute Bill?

Alan Johnson: I will have another look at the hon. Gentleman's excellent ten-minute Bill, and will doubtless talk about it in the many meetings I have with the Secretary of State for Children, Schools and Families. The hon. Gentleman makes an important point, and one of the fundamental reasons why the NHS in London is proposing polyclinics in London is the number of people clogging up accident and emergency departments who should really be in primary care.

James Duddridge: Is the Secretary of State aware that some hospitals have banned people from bringing in flowers for patients on health and safety grounds, and what guidance, if any, does he have for these hospitals?

Alan Johnson: I have a full briefing with me that relates to every issue under the sun, but not this one. I do not think that it is a matter for me; I think it is for the local trusts, and I would be very surprised if they took that decision on any grounds other than patient safety. I believe that health care-acquired infections may well be the reason these flowers have been banned, but I will find out, perhaps, and write to the hon. Gentleman.

Graham Stuart: Does the Secretary of State share my concern that 1 million people appear to have been treated under NHS dentistry since the new contract came in, and that there also appear to be perverse incentives within the contract so that dentists are encouraged by the financial set-up not to treat those with the greatest oral health need? Could we not have a perverse outcome whereby those with least in our society will be able to tell their social class by the state of their teeth—and under a Labour Government?

Alan Johnson: The hon. Gentleman was probably mistaken in saying that he thinks that there are 1 million more dentist appointments now, because he probably meant the reverse—I do not accept what he says either way. I believe that this is a big issue in relation to heath inequalities, which is why I announced to Parliament our intention to introduce fluoride in more areas. That is the single biggest contribution that we can make to tackling health inequalities. On the dental health of young children in this country, our 12-year-olds have the healthiest teeth in the whole of Europe. That is a great tribute to the dental profession, and I would think that it is not detrimental to the amount of investment that this Government are putting into dental care.

Greg Mulholland: I welcome the fact that the Government are finally talking about reform of our system of care for the elderly. Given the urgency of the crisis—Help the Aged describes our system as being in crisis, Age Concern calls it a disgrace and the Local Government Association yesterday said that it is coming apart at the seams—will the reform, and the legislation to enable it, be brought before the House before the next general election?

Ivan Lewis: May I say to my good friend that as well as the long-term review, we have, from April, been introducing a transformation programme in every local authority area, supported by £500 million of reform money over three years? We will soon be publishing the first ever national dementia strategy and end-of-life strategy; we have announced the extension of our "Dignity in Care" campaign; the Secretary of State has announced a new package of preventive health measures specifically to support older people; we are extending the Human Rights Act 1998 to publicly funded residents of private care homes; and we have announced a new 10-year strategy to support carers. I am not sure that the hon. Gentleman's party has anything else to offer on this issue.

Points of Order

Sally Keeble: In response to my question, the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), said that she would arrange for a paper to be placed in the House of Commons Library. I checked, and it has not been placed there. I wonder whether it could be placed there today, because it contains important information that answers questions in which hon. Members would be interested.

Dawn Primarolo: indicated assent.

Mr. Speaker: The point has been answered.

Jim Devine: Reference has just been made to the report on the Nursing and Midwifery Council that was published yesterday, which highlighted the fact that that body was not fit for purpose and had a bullying culture. That vindicated claims made by many on both sides of this House and, in particular, by my constituent, Moi Ali, who is the whistleblower in this matter. She is a black lady who has a claim for racism against the NMC. She has used the internal systems and approached people, including her MP, externally to raise the matter. Because of Buggin's turn, she is the vice-president at the moment and, sadly, she is being pressured to resign from her job. I wonder whether, through your good offices, Mr. Speaker, the Minister with responsibility could come to the House to make a statement on that report?

Mr. Speaker: I am not going to be drawn into that matter.

Local Authorities (Social Equality Audits)

Karen Buck: I beg to move,
	That leave be given to bring in a Bill to require local authorities to collate and publish specified social, economic and other data on an annual basis; and for connected purposes.
	The debate about social inequality is beset by stereotypes and simplification. Sometimes stereotypes give us an indication of the truth, but they frequently conceal more than they reveal. So, we hear a lot about the north-south divide, and unemployment and incapacity benefit figures are frequently portrayed exclusively in terms of decayed former industrial communities in the north or in the Welsh valleys. Sometimes Tower Hamlets is contrasted with the Royal Borough of Kensington and Chelsea in what is frequently described as a tale of two cities, revealing the stark divide in average incomes, house prices and life expectancy.
	Such attention is broadly welcome because it highlights the continuing extent—and in some ways the worsening or intensification—of the toxin of inequality. It is even more corrosive than poverty, in its own insidious way, as has been so well documented by academics such as Richard Wilkinson. Inequality damages health, undermines community cohesion and is now understood to be more closely correlated with crime than poverty itself.
	Inequality is poorly understood. Last year's report for the Joseph Rowntree Foundation confirmed that people's knowledge about inequality is limited, and attitudes are complex, ambiguous and apparently contradictory. In turn, policy makers know little about how the perceptions people have are formed, or changed. We could simply choose to ignore the ramifications of inequality, precisely because public attitudes are complex and contradictory. But by doing so, we would be turning our backs on a very real problem. Over the past 20 years a consistently large majority of people have considered the gap between rich and poor to be too large, and only a small minority of people feel that the Government are doing too much to address the problem.
	My Bill is intended to make a small contribution to increasing awareness and understanding of social inequality. I seek broadly to mirror the important work done by primary care trusts in their annual public health reports, which have come into their own in recent years as an essential source of data about health inequalities. By requiring all local authorities to produce an annual audit, based on a core basket of indicators, I would hope to achieve three things. First, I would like to get beyond stereotypes, whether of the north-south divide kind, or the Tower Hamlets versus Kensington and Chelsea variety. The reality is far more complex than such stereotypes would have us believe and generalisations limit understanding, not deepen it.
	Secondly, I hope that the process of producing and publishing annual audits would generate interest and debate among local policy makers, the media and others, precisely because the information would be local. Of course, there are no guarantees that such interest would sharpen the focus on deprivation and inequality, but it would certainly offer communities a set of tools to hold policy makers to account. That is certainly the experience of PCTs and public health reports in recent years.
	Thirdly, requiring a core set of indicators that apply to all authorities would enable more specific comparisons between small areas across the country. It would also promote a wider and more interesting debate nationally about the causes of inequality and social deprivation.
	I confess to a personal stake in this issue. The local councils that make up my constituency—Westminster and Kensington and Chelsea—consistently come near to the top of national league tables for wealth and income. The prosperity of Knightsbridge, Belgravia and Chelsea, where some councillors think that international bankers constitute a "hard to reach group", masks the fact that, as recent reports have confirmed, the Mozart estate in Queen's Park in my constituency is the most deprived neighbourhood in the whole country, and Westbourne ward has the country's highest proportion of children in workless households. But I—and my colleagues in other areas with generally affluent average figures—struggle to get the implications of that understood locally and nationally, and families and pensioners living in poor neighbourhoods in such areas lose out in consequence.
	Local authority social equality audits would be based on existing sources of data. I am not seeking to saddle councils with major new duties in collecting and analysing information, but to bring the vast array of data already buried in the vaults—locally and nationally—blinking into the light.
	What would be included? Obviously, I would want short profiles of all neighbourhoods, which currently stay anonymously labelled as "super output areas" buried in the Office for National Statistics. Which are the most prosperous areas and which the poorest? We already have information on employment levels, and the number of children in workless households—that is, families surviving on less than £10 per day for fuel, food, clothing and treats. I would want to include data that exist but are unpublished, collected in school information profiles. League tables offer us information on key stage results and useful, though poorly understood, contextualised added value, but they should be complemented by the information that we hold on all schools about free school meal entitlements and other proxies for deprivation.
	Harsh words about school performance miss the target when the breathtaking variations we see in school intake receive so little attention. It would also be useful to include information on benefits and services delivered by local authorities, including housing benefit and take-up of child care and out-of-school services. That would enable more informed discussions about local welfare-to-work policies, the impact of local authority charging policies and so on.
	Audits would not be exclusively about ward or neighbourhood data, either, but would include local authority rankings on key deprivation indicators and proxies for deprivation, such as substandard housing, overcrowding and homelessness. Of course, as has proved to be the case with PCT public health reports, it would be good to see themes emerge and to see priorities set from year to year between different communities that reflect local circumstances so that audits become dynamic tools, complementing and informing local area agreements and council decision-making processes.
	Information does not by itself make wrongs right. Information can be powerful and can do harm if abused or used partially or selectively, yet the alternative is far worse. We should no more be ignorant about poverty and inequality than we should be about climate change or any of the other great issues of our time. By offering local communities, policy makers and the media clearly presented and comparative data, we might not get all of the right answers but we might at least ensure that people are asking the right questions.
	 Question put and agreed to.
	Bill ordered to be brought in by Ms Karen Buck, Mr. Iain Duncan Smith, Mr. David Blunkett, Mr. Frank Field, Simon Hughes, Fiona Mactaggart, Mr. Gary Streeter, Martin Salter, Mr. Terry Rooney, Clive Efford, Lyn Brown and John Battle.

Local Authorities (Social Equality Audits)

Ms Karen Buck accordingly presented a Bill to require local authorities to collate and publish specified social, economic and other data on an annual basis; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 17 October, and to be printed [Bill 122].

Opposition Day
	 — 
	[14th Allotted Day]

Polyclinics

Andrew Lansley: I beg to move,
	That this House opposes the Government's plans to impose a polyclinic, or GP-led health centre, in every primary care trust; regrets that this could result in the closure of up to 1,700 GP surgeries; is concerned that the imposition of polyclinics against the will of patients and GPs could be detrimental to standards of care, particularly for the elderly and vulnerable, by breaking the vital GP/patient link; further regrets that these plans are being imposed without consultation; is alarmed at the prospective loss of patient access to local GP services at a time when care closer to home should be strengthened; believes that the Government's plans would jeopardise the independence and commissioning capability of general practice in the future; supports the strengthening of access to diagnostic and therapeutic services without undermining the structure of GP services; and calls on the Government to reconsider its plans for polyclinics.
	Last Thursday, the local medical committees, which are the statutory bodies required to represent GPs across the country, met in conference and passed a vote of no confidence in the Secretary of State and the policies of the Labour Government. On the same day, the British Medical Association delivered to Downing street a petition against the Government's polyclinic proposals consisting of 1.2 million signatures. Patients care about the future of their local surgeries and about their GP services. They and GPs are concerned that the Government's top-down, one-size-fits-all imposition of polyclinics in London and in each primary care trust across the country will reduce access to their GP services and undermine the GP-patient relationship, which is at the heart of the successful delivery of health care.
	Today's motion is very simple. It urges the Government to think again. If the Government had offered additional funding to support the creation of extra GP practices in under-doctored areas, we would have supported them.

Elliot Morley: My local primary care trust has announced that we are to have an additional clinic, funded with additional money, in an area where some of the GP lists are full, which is an area of deprivation. The clinic will be open from 8 am to 8 pm and will provide drop-in services not only for the local community but for the whole area. Is the hon. Gentleman saying that he would deny the people of Crosby that clinic?

Andrew Lansley: No. The right hon. Gentleman should remember that back in January 2006, the Government promised to provide additional general practitioner services in under-doctored areas such as his. The fact that they are doing that two and a half years on should not be a cause for congratulation; it should be a cause for regret that it has taken so long. My point is simple—

Elliot Morley: rose—

Andrew Lansley: No, I will answer the right hon. Gentleman's first question before I come on to the next one. The point is that we need additional GP services in under-doctored areas, and the decision on where and how those services are structured must be the product of local consultation and agreement, based on local needs and circumstances. For some time—for two and a half years—the Government have been saying that they will provide additional GP services in under-doctored areas, and we are not disputing the need to do so.

Tony Wright: The hon. Gentleman mentioned petitions; I went to see my GP the other day, and the receptionist was giving out petition forms. Someone asked what the forms were for, and the receptionist said, "They're going to close all the local surgeries down." That is complete nonsense, and the hon. Gentleman knows it, so why does he go along with it?

Andrew Lansley: It is the British Medical Association's petition, not mine. The Secretary of State and the Minister of State, the hon. Member for Exeter (Mr. Bradshaw), are suggesting that 1.2 million people across the country are being conned by their GPs, but that is not true. The Minister of State pops up and says that the Department had one e-mail from someone saying that they did not really believe in the petition, so I have asked the Minister whether he will publish all the e-mails presented, and every representation made, to the Department of Health. The fact is that across the country doctors have been voicing their concerns that their practice will be undermined to their patients, and I will explain in my speech why those concerns are valid. Doctors have concerns about the impact that the imposition of a polyclinic will have on their practices.

Shona McIsaac: Will the hon. Gentleman give way?

Andrew Lansley: I will come to the hon. Lady in a minute. The first point to make clear is that the Government could have gone ahead in a far simpler, better fashion. They could have offered primary care trusts extra funding to provide additional practices in under-doctored areas. They could have offered funding to each primary care trust across the country to enable them to provide access to diagnostics and additional therapies in each area, in places that would have made sense from the point of view of local GPs. Everywhere that I have been—that is quite a lot of places—GPs would very happily have got together and agreed where it would be appropriate for such diagnostics and therapies to be available.

Peter Bottomley: Is not the point that over the past 10 years the Government have set up a system for commissioning, and are now going outside it, and that any PCT that declines to put a polyclinic somewhere in its area will get disciplined? Is that not shocking?

Andrew Lansley: Yes, it is, and that is the way in which the Government now work. It is simple to say why GPs and patients across the country are angry: it is because, contrary to the Government's rhetoric about local decision making, and contrary to the Minister's rhetoric about all the proposals coming from primary care trusts, it is an imposed plan, generated inside the Department of Health and adopted by Ministers who should have known better.

Tobias Ellwood: To go back to the first intervention, the people of Crosby may be delighted that there is to be a polyclinic there, but the people of Bournemouth are concerned, and doctors are worried about the patient-doctor relationship being eroded as a result of polyclinics being created. Does my hon. Friend agree that it would have been better to have allowed Bournemouth and doctors an opportunity to have a say in the matter, and then to have determined whether a polyclinic was appropriate?

Andrew Lansley: I absolutely agree with my hon. Friend, and he rightly reflects precisely the kind of points that are being made to all Members of the House. Labour Members may not admit it, but they know that GPs are telling them that they cannot see the rationale for many of the proposed imposed polyclinics across the country.
	The Government were not content to bring forward proposals that would have made sense and could have been adapted and used locally. Gripped by a desire for the latest imported ideology of polyclinics, they first told London that there would have to be 150 polyclinics in the capital, and then told every primary care trust that they should have one each.
	Of course, we need to strengthen primary care—no one disputes that—but Martin Roland, who is director of the National Primary Care Research and Development Centre in Manchester, said in the  British Medical Journal in March:
	"Increased patient choice requires more high-quality practices, not the small number of large practices that some polyclinic models suggest. We know that patients in small practices rate their care more highly in terms of both access and continuity. Indeed, although small practices show more variation in quality, on average, they achieved slightly higher levels of clinical quality than larger practices in the quality and outcomes framework."

Shona McIsaac: rose—

Karen Buck: rose—

Andrew Lansley: I will give way to the hon. Member for Cleethorpes (Shona McIsaac), but perhaps the hon. Member for Regent's Park and Kensington, North (Ms Buck) will explain later why smaller practices that get better outcomes on the quality and outcomes framework will be shut down in favour of larger practices.

Shona McIsaac: I ask the hon. Gentleman to follow up what was said by my right hon. Friend the Member for Scunthorpe (Mr. Morley). I represent the rural part of north Lincolnshire. We will get a new clinic in north Lincolnshire, but the PCT has told us that that is a local decision to meet local need, and not one rural GP practice will close as a result of these plans. So why is the hon. Gentleman and his hon. Friends scaremongering to the extent that my residents think that their practices will close?

Andrew Lansley: That is quite interesting, but the hon. Lady needs to look at the material published by the North East Lincolnshire PCT to accompany its memorandum of information, which sets out 34 practices that will be in the proximity of the new polyclinic in Grimsby, with all the implications that might flow from that. That is what we have seen across the country. We are not scaremongering; people are looking at the material published by PCTs across the country. The Secretary of State for Health peddles the same line as the hon. Lady in saying that no GP practice will be affected and closed, but his own PCT in Hull says that the process will be used as a lever for the reconfiguration of GP services and that, at the end of the day, there will be fewer GP sites.

Alan Johnson: The hon. Gentleman has twice mentioned my constituency. What Hull is doing of its own volition is going out to consultation at the moment, and the proposal is additional to the proposals for the new centres that will come to under-doctored areas and additional to the GP-led health centre that we are putting into Hull. It is consulting on three additional health centres to deal with three problems: first, a preponderance of single-handed GPs; secondly, facilities and services that do not even meet the Disability Discrimination Act 2005; and thirdly, the fact that it has no women doctors whatsoever. So the PCT has gone out to consult the people of Hull, quite separately from what we are doing nationally, to seek to address those problems, and so it should.

Andrew Lansley: The Secretary of State is getting desperate. I have here the presentation document from Hull PCT. If it devised the proposal, why does the powerpoint presentation say, "Darzi GP-led health centre"? It does not say that it is something that the PCT thought up. The proposal's criteria are exactly those that the Department of Health have specified. The document's conclusion says:
	"The number of GP sites will reduce."
	 [ Interruption. ] Labour Members should listen. If the Secretary of State is saying that Hull PCT will provide three additional GP health centres, how come the impact will be that the number of GP surgeries will reduce? We know exactly what that means.

John Redwood: Is not the central point that we are very happy to see polyclinics if they are additional and wanted by the local community? The element of compulsion is quite wrong, and Labour Members have got a real shock coming to them when they discover that, in their areas, GPs will dislike it but be dragooned and that they will lose their current practices.

Andrew Lansley: I agree, and my right hon. Friend has a reasonable complaint if the Government are providing additional money in his area only on the basis that it will be spent in a certain way. If I recall correctly, his PCT is the lowest funded per capita in the whole country. If anywhere in the country should be given the opportunity to spend the money as it sees fit, it is his constituency.

Simon Burns: I assure my hon. Friend that certainly GPs in Chelmsford do not think that he is scaremongering in any way. Mid Essex PCT is being forced to have a polyclinic in Chelmsford and GPs in the area are extremely worried that it will have a serious and negative impact on their practices, because of the nature of the things being imposed on them.

Andrew Lansley: I am grateful to my hon. Friend, who has gone to the heart of the issue. At the moment, the Government require PCTs to publish memorandums of information before in effect tendering for the new polyclinics. We have seen the tender documents from 58 PCTs, which identify 608 GP surgeries in proximity to proposed polyclinic locations. Because the Government have insisted that the new polyclinics should register patients, the local practices identified in those documents will see their patient lists undermined, some of them potentially fatally.
	The Secretary of State has said that no GP surgery will be closed as a consequence of opening polyclinics, but how can that be true? The Government amendment does not refer to the polyclinics proposal for London, which we should address for a second. The Prime Minister got up at the Dispatch Box and said that there would be 150 polyclinics, that each polyclinic would have 25 GPs and that each polyclinic would serve 50,000 people. The consequence of that would be the closure of more than 70 per cent. of existing GP surgeries in London.
	Documents from half the PCTs refer to 600 GP surgeries in proximity to potential polyclinics. If the polyclinics are not additional and the GPs in them are the same GPs who currently work in their own surgeries—or, for that matter, salaried doctors in PCTs—then a number of surgeries will have to close. That was the clear implication of the Government's proposals for London. If that is not the case and the GPs are genuinely additional GPs in additional GP practices, where will the money come from? We have done that calculation, too. If the Secretary of State is to be believed and the provision is all additional, the cost of that number of GPs in that number of surgeries would be £1.6 billion a year. However, the Government have allocated £250 million over three years, so the situation simply does not add up. One of two things must be true. Either the GPs will be moved and the practices will be moved from their present locations into larger polyclinics, or additional services will be provided and additional costs will be incurred. The Government have not answered the question about which one of those two things it will be.

Karen Buck: In my PCT, the thinking concerns creating a polyclinic based on a hospital. That would reduce inappropriate accident and emergency attendances by people who are not registered with doctors, which hammers the hon. Gentleman's argument that there is a one-size-fits-all solution. Is it not true that in 1981 the Acheson report addressed the issue of single-handed practices, particularly in London, where single-handed practices were over-represented? For 16 years, Conservative Governments made progress—not enough in my view—on reducing single-handed practices. Although there is good practice in some single-handed practices, by and large the quality of care is not as good as that provided by other practices. Is the hon. Gentleman saying that his party stands four-square behind all single-handed practices, regardless of the quality of care?

Andrew Lansley: Nobody could responsibly say that "regardless of the quality of care". The hon. Lady has said that we have suggested that there is a central plan, but I did not make that suggestion. Ara Darzi produced "A Framework for Action" for London, which set out the specific design for a polyclinic—25 GPs, 50,000 people, £800,000 a year rent, a number of out-patient attendances, the employment of a consultant and the provision of a number of nurses. I did not make that up; the Prime Minister stood at the Dispatch Box and paraded the fact that there would be 150 polyclinics in London. It is absurd that the hon. Member for Regent's Park and Kensington, North has challenged us on single-handed GPs when the evidence is clear that the best quality and outcomes framework results are achieved by practices with two or three GPs.  [ Interruption. ] I know that they are not single-handed practices. Why do the Government propose to push GPs from across London into large polyclinics, when the evidence is clear that accessible local surgeries with two or three GPs achieve the best results?

Tony Baldry: My hon. Friend has said that the situation is absurd, but there is a further bizarre twist. Is he aware that the Darzi clinics will not be subject to monitoring by health overview and scrutiny committees? The Government are introducing a two-tier NHS: parts of the NHS are subject to scrutiny by health overview and scrutiny committees, whereas independent treatment centres and Darzi clinics will not be subject to scrutiny and monitoring by health overview and scrutiny committees, which seems fundamentally wrong.

Andrew Lansley: I agree with my hon. Friend.  Pulse recently looked at the proposals in PCTs, and only a tiny proportion of those that it looked at had been subject to even a semblance of a public consultation. The reason is precisely the same as the reason that my hon. Friend gave: the Government are determined that the proposal should not be subject to scrutiny. Why? Because it will not stand up to that scrutiny, it is not locally determined, it does not arise out of the needs and circumstances of the area and, on the quality of care that will be provided, it is not even evidence-based.

Robert Goodwill: If the aim of the proposal is to force the closure of single-handed practices, why are the Government going to parachute a polyclinic into the middle of Scarborough, where we have a number of good group practices, but not into rural areas, where we have some very good single-handed practices? It does not even follow the logic of the hon. Member for Regent's Park and Kensington, North (Ms Buck).

Alan Johnson: Work it out for yourself.

Andrew Lansley: The Secretary of State says that my hon. Friend can work it out. The reason may be that the chairman of the BMA council is a GP in Scarborough, but there we go. We will see whether the Government's conspiracy extends even to that. What my hon. Friend says is absolutely true. I have been to rural areas and talked to the head of the local medical committee in north Yorkshire, and it is completely absurd that a town such as Scarborough, which has many health needs but is not under-doctored in terms of GPs, should have money spent on it in that way. Throughout north Yorkshire, it is perfectly clear that access to diagnostics and therapies is required in a range of market towns and centres, not in one centre at the furthest extremities of the area. That is absurd. As it happens, north Yorkshire is technically among the most-doctored areas in the country.

Graham Stuart: May I thank my hon. Friend for supporting my right hon. Friend the Member for East Yorkshire (Mr. Knight) in his campaign to defend health services in Bridlington, and share with my hon. Friend the concern of people along the east Yorkshire coast about polyclinics being imposed on the area? Bridlington, while its hospital services are being devastated, is having a polyclinic imposed and being told that it represents an improvement in its health care.

Andrew Lansley: It is risible. My hon. Friend will know that from his experience, as will my right hon. Friend the Member for East Yorkshire (Mr. Knight), who represents Bridlington. We visited Bridlington and District hospital together, and it is outrageous that the Government appear set on downgrading its services and then, in pursuit of a "care closer to home" philosophy, on undertaking re-provision on the same site—dressing it up as a polyclinic. We live in bizarre times.

Several hon. Members: rose —

Andrew Lansley: No, I shall not give way.
	The hon. Member for Regent's Park and Kensington, North was quite right to talk about London earlier, but it is important to understand that, far beyond that, there are considerable implications in rural areas. My hon. Friend the Member for Scarborough and Whitby (Mr. Goodwill), and my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) in the East Riding, made it clear that there are rural areas where spending such money, so that a polyclinic is established in a place that is already well doctored, is not only wasteful of resources and prejudicial to the GP practices in the area, but, if it threatens other surgeries, could have serious implications for access.
	We have done the calculation on access to GP surgeries, and NHS London made a calculation in its consultation document. It says that it has done high-level modelling, meaning that people in London will be on average only 1.5 miles away from their GP surgery. That is quite interesting, because NHS London did not go on to say that, currently, people in London are on average just half a mile away from their GP surgery. So when the Secretary of State says that he is perfectly willing to campaign on the issue, perhaps he would like to tell all the people of London that the distance to their GP surgery will triple. It is quite clear: we have done the calculation and NHS London said that the distance would be 1.5 miles.  [ Interruption. ] It is quite clear. It is a good one. Don't you worry, it is.  [ Interruption. ] Actually, Ministers should know that the distance will triple in Hull and in Exeter.
	In places such as North Cornwall, the distance to a GP would more than triple, rising to more than 9 miles on average. The Government are parading their belief that they can improve access to primary care, but nobody, anywhere in the country, will be able to believe the Government's arguments if their access to a local surgery is so prejudiced. There is an enormous difference in London between going half a mile and going a mile and a half. Someone who is elderly, vulnerable, frail or a mother with children, without access to a car, becomes reliant on public transport. In rural areas, access to public transport over many of these distances is difficult to contemplate.

Andrew George: rose—

Andrew Lansley: I mentioned Cornwall, so I must give way to the hon. Gentleman.

Andrew George: I agree with the hon. Gentleman in so far as the Government will end up with another independent treatment centre-type fiasco if they continue with the top-down restructuring of the type that he is criticising. He said earlier that these services should be largely designed by GPs. May I seek a reassurance that he is really trying to tell us that patients and local communities should have a big say in how primary care is designed—that it should not be designed by central Government and imposed on the local community or by those who are contracted to provide the service but designed by the local community itself?

Andrew Lansley: I commend to the hon. Gentleman our document, "The patient will see you now, doctor", published last September, which clearly set out how we would seek to empower patient choice and involvement, the effect of which would be increasingly to design primary care services around the needs of patients.
	The Government and primary care trusts have gone ahead without the semblance of a public consultation. Where, in all this, is the evidence to justify the Government's imposition of this plan? Since they published their proposals, the King's Fund, which I am sure that Ministers will acknowledge is independent and respected, looked at the evidence for polyclinics under three criteria—quality, cost and access. On quality, it said:
	"The co-location of multiple services presents opportunities for delivering more integrated care, particularly for people with chronic diseases. However, the evidence suggests that in practice these opportunities are often lost."
	On cost, it said:
	"Expectations that community-based services will be less costly than hospital-based equivalents are frequently not met."
	On access, it said:
	"If a substantial centralisation of primary care were pursued, the consequent reduction in access to these services would be a major sacrifice."
	Overall, it concluded:
	"A major centralisation of primary care is unlikely to be beneficial for patients, particularly in rural areas."

Howard Stoate: rose—

Andrew Lansley: Perhaps the hon. Gentleman can explain how patients will benefit from this centralisation of services.

Howard Stoate: I think that the hon. Gentleman is concentrating too much on one particular type of polyclinic. There are many models. There is nothing to say that a polyclinic has to include every local GP. There is plenty of opportunity for hub and spoke models whereby the local GPs can remain and the polyclinic can provide central services such as X-ray, physiotherapy, consultant services and so on. There are also models where individual practices can co-locate into polyclinics and remain as individual practices. There are many examples around the country of that happening. The opportunity exists for primary care trusts to negotiate and discuss with local GPs and other providers how that type of model can benefit their area, thereby allowing patients to get the benefit of small practices and central services in one locality.

Andrew Lansley: I have heard that before. The fact is that if there were going to be a hub and spoke model in London, why did the framework for action describe a polyclinic model of 25 GPs and 50,000 people? Why did the Prime Minister refer at the Dispatch Box to 150 polyclinics? Why are GPs in north London telling me that the primary care trust is saying that if they do not move into the polyclinic, their rent reimbursement will be stopped? A GP wrote to me and said that he knew what was about to happen to him because the primary care trust published a map of primary care services in his area and he was left off.

David Taylor: The official Opposition are coming rather late to this issue. People such as myself tabled early-day motion 1465, which flags up the more fundamental flaws with polyclinics outside London and the metropolitan areas. A fatal flaw of the Conservative motion is that it does not consider the potential of free market competition to inflict serious damage to patient access to general practice and public services. No wonder firms such as Serco, UnitedHealth and Virgin Healthcare are lining up outside the Department of Health just outside this place, licking their lips at the prospect of extracting vast sums from the NHS. Why is that not referred to in the Opposition motion? It deserves to fail because of that.

Andrew Lansley: It is not there because when I have talked to, for example, GPs in Islington who were very unhappy about the way in which a tender was awarded to a commercial organisation, I found that they were willing to enter into competition as long as it was fair, and as long as it was based on a level playing field. I am not opposed to personal medical services or alternative, commercially run, providers of medical services practices, but I am opposed to the top-down system of imposing polyclinics, which is undermining the existing GP structure.
	It is interesting that the Prime Minister, when challenged at his press conference last week, retorted that there would be thousands of additional GPs. I think that he said that there are already thousands of additional GPs—[Hon. Members: "There are."] Of course there are more GPs since 1997, and so there should be. But in the last year for which figures are available, 2006-07, there were only six additional GPs in the whole country, so the Government are not in a position to make much progress on that issue. The predictions from the King's Fund in its recent document show that we would be short of 2,000 full-time equivalent GPs by 2016. Where is the flow of additional GPs who are to fill the polyclinics?
	If polyclinics take over existing GP services, local practices cannot be maintained. If primary care trusts provide the funding for polyclinics, they will, as a consequence, force the closure of many other local GP services because it is not possible to use the same money twice. The Secretary of State knows that, but he will not admit it. There is a long-term agenda in his Department to undermine the independent contractor status of most GPs and to compel them to become part of a PCT-controlled primary care structure. That is why a GP in London said the other day that the PCT was
	"bending everyone's arms very strongly. Life will be very difficult if we don't go in."
	It is interesting to note that the Government's amendment to the motion does not actually mention polyclinics. I suppose that the Secretary of State is going to pretend that they are health centres, not polyclinics. The Minister of State, the hon. Member for Exeter, is constantly saying that people get confused because those centres are health centres, not polyclinics. I received two answers from the Minister of State on this subject. On 15 May, he said:
	"'Health centre' is a term used to describe a range of health services characterised by the co-location and integration of different services, including those traditionally provided in a hospital setting."—[ Official Report, 15 May 2008; Vol. 475, c. 1666W.]
	A month later, on 16 June, he said:
	"'Polyclinic' is usually a term used to describe a range of possible health service models characterised by the co-location and integration of different services, including those traditionally provided in a hospital setting."—[ Official Report, 16 June 2008; Vol. 477, c. 767W.]
	Those definitions are absolutely the same. As far as I am concerned, if it walks like a duck and quacks like a duck, it is a duck.

Peter Atkinson: Will my hon. Friend give way?

Andrew Lansley: No, I shall finish now, if my hon. Friend will forgive me.
	If the structure proposed forces local GP surgeries to close, forces GPs into becoming salaried employees of their primary care trusts instead of independent contractors and turns patients into through-puts rather than people, it is a polyclinic. We should follow the evidence, which says that smaller practices are often of higher quality. We know that they are more accessible. We know that patient choice and preference show that they value continuity of care even more highly than rapid access to care. We know that integrated care is about a lot more than putting all the services in one large building. How can access and care closer to home be improved if hospital services are closed down while polyclinics are built on the same site? Why are the Government so obsessed with the ideology that they have brought in, when they should understand that primary care in Britain is one of our comparative strengths? We should develop and strengthen our structure of primary care, not replace it with a German or a US-style polyclinic system.
	All hon. Members should be aware of the concern raised throughout the country because of the Government's top-down imposition of polyclinics. There is a better way. We can strengthen access to community services and strengthen the existing GP structures. We can extend GPs' commissioning and their responsibility for providing integrated care for their patients. We can use those additional resources to improve access to community services while maintaining access to GPs locally. We can empower patients to choose their general practice and to drive up quality and access improvements through their choices. That would be a better way. The Government should reconsider their polyclinic plans. The motion would require them to do so, and I commend it to the House.

Alan Johnson: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"welcomes the Government's support for primary care and proposals to invest £250 million in 113 new GP practices in the most deprived communities and 152 new state-of-the-art GP-led health centres open from 8 a.m. to 8 p.m., seven days a week, in every part of the country; notes that these centres will offer a wide range of health services including pre-bookable GP appointments and walk-in services for registered and non-registered patients; recognises that the exact format and location of each GP-led centre will be decided locally in consultation with patients; notes that GPs will not be forced to work in the new GP-led centres and where that is the case patients will still be able to remain registered with their GPs at their existing location and premises; acknowledges that the expansion of primary care is essential if the overall health of the population is to improve, and inequalities in health are to be addressed; and welcomes plans to ensure enhanced primary care services are capable of meeting the new challenges facing the NHS including tackling lifestyle diseases such as obesity and through more effective screening programmes for the general population."
	We are delighted that the hon. Member for South Cambridgeshire (Mr. Lansley) has used up another of his party's Opposition day debates to allow us to reiterate our commitment to primary care, set out our record of investment and reform, and explain in detail our exciting plans to expand capacity in primary care.
	No previous Government have more clearly demonstrated their commitment to primary care and those who work in it. Let us examine the record since 1997: investment in primary care has more than doubled; there are more than 5,000 more GPs and more than 4,400 more practice nurses; GP pay has increased by around 55 per cent. in real terms; GP hours have reduced by 17 per cent., and the time spent on each patient is up by 50 per cent. That is hardly the record of a Government who are hostile to the role of primary care in the NHS.
	I want to set out as clearly as possible exactly what the Government propose throughout the country, what the NHS is seeking to do in London, and to mention briefly other separate developments that clinicians, patients and managers in local PCT areas, including—I am pleased to say—Hull, are leading.
	Let me begin by stating firmly what we do not propose. According to the BMA and its political wing opposite, the Government have not one but three evil ulterior motives: to privatise primary care by allowing companies such as Boots to run GP services; to nationalise primary care by making GPs state employees; and to destroy family practices by breaking the GP-patient link.

Andrew Lansley: Look behind you.

Alan Johnson: Conservative Members claim that the accusation of privatisation comes from behind me, but it appears in every BMA leaflet that I have read, at the same time as that of trying to make GPs do what Bevan could never make them do—become state employees. So we are trying to privatise and nationalise simultaneously.

Michael Jabez Foster: The GPs of Hastings and Rye are not persuaded that the BMA has got it right. Not one has complained. They are delighted with the £15 million that my right hon. Friend has made available for a new health centre in the town centre. Patients are not compiling petitions, either.

Alan Johnson: My hon. Friend's experience is replicated throughout the country.
	We are supposed to have three ulterior motives. All that is arrant nonsense. It is possibly the most ludicrous misrepresentation made in the House since the equally ludicrous attempts to distort the principles behind the establishment of the NHS 60 years ago, and it derives from exactly the same source.
	The motion refers to a Government plan to "impose" "polyclinics." Opposition Members deliberately use that term because of its impersonal and biomedical connotations. There is a perfectly valid argument for polyclinics. There is no argument for imposing them centrally on every locality as a replacement for GP practices—that is why we do not have such a plan. A polyclinic combines primary and secondary care. The only part of the country where a network of polyclinics is proposed is London, where a comprehensive review of health services took place last year, and the Government had no say in its outcome. It was a London consultation, which the NHS in London led.

Joan Ryan: The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned north London. In my constituency, the chairman of the local medical committee, who is a local GP, made it clear that premises are limiting the advantages that GPs can offer patients. A plan that provides GP centres is therefore important. It is likely to give us a GP centre in Enfield Lock and in Enfield town—exactly what Sir George Alberti, a leading clinician, said that we need. The people of Enfield, North will not be deprived of that huge investment by the Conservative party's propaganda.

Alan Johnson: My right hon. Friend makes an important point about health services in London. We had no role in the outcome of that review; however, like the population of London, we support NHS London's proposals. I want to take a minute to explain to the House why the proposals, which those on the Opposition Front Bench oppose, are right for London.

Jacqui Lait: If the footfall of a centralised primary care centre is 50,000 people, that adds up to about 50 per cent. of all the GP practices in any one constituency. As a south-east London MP, I should be grateful if the Secretary of State said whether he is seriously proposing that 50 per cent. of our constituents go to one place for their primary care?

Alan Johnson: I am suggesting that the hon. Lady, like her colleagues on overview and scrutiny committees throughout London, participate in the London consultation, the outcome of which has shown wide support from both the public and politicians of all political persuasions for what is being proposed in London, and well it might.
	We hear the trite comments from the Opposition Front Bench, but people in London do not have access to the quality of primary care that they deserve. There are particular problems with access in this city. An Ipsos MORI poll of Londoners revealed significantly lower satisfaction ratings than the national average, and that 54 per cent. of GP practices in London have only one or two GPs, compared with 40 per cent. elsewhere, that nearly 20 per cent. of GP practices in London are unable to offer an appointment 48 hours in advance, that demand for longer opening hours is even higher than in the rest of the country, that 50 per cent. of all patients who attend A and E departments in London can be better treated elsewhere, and that more people clog up A and E in London than in any other city.

Graham Stuart: rose—

John Redwood: rose—

Angela Watkinson: rose—

Alan Johnson: I give way to the London MP.

Angela Watkinson: One of the justifications for polyclinics is the extension of GP availability. Healthcare for London quotes the patient survey of 2007 as saying that the majority of patients are dissatisfied with their GP's opening hours. However, the British Medical Association quotes the same survey as saying that 84 out of 100 people are satisfied with their GP opening hours, so is it not better to listen to individual patients and individual GPs? I have not had one GP or patient from my constituency contact me to say that they are in favour of polyclinics.

Alan Johnson: The hon. Lady is referring to the Healthcare Commission report, which was not a London-only survey and which showed a high level of satisfaction with GP opening hours. However, the 84 per cent. in favour left some 6 million people throughout the country who were dissatisfied. When one looked into the figures, one found that people from black and minority ethnic communities, such as the Bangladeshi community, those from poorer backgrounds and, in particular, those from London were much less satisfied than the rest of the country. According to a BMA survey, 60 per cent. of London GPs say that their facilities are unsuitable for current needs, 75 per cent. think that they cannot meet future needs and 36 per cent. doubt whether their facilities could be adapted to meet the access requirements of the Disability Discrimination Act 2005. Those are the problems in London, which London is seeking to resolve.

Graham Stuart: The Secretary of State is talking to a large extent about London. Can he tell my constituents why he wishes to impose a polyclinic on the East Riding of Yorkshire PCT, where I assure him there is very little appetite for one? This morning, a GP from Beverley told me:
	"Polyclinics will lead to the end of personalised care which current patients enjoy."
	That GP, who is nearing the end of his career, also said—perhaps this will rock the Secretary of State most—that he has voted Labour all his life, but will not do so at the next election, because he has lost confidence in the Government on health.

Alan Johnson: Let us stick to London for a second.

John Redwood: Will the Secretary of State tell us what the total cost will be of this elaborate reorganisation?

Alan Johnson: The total cost is estimated at around £150 million, which will be money well spent and a crucial investment in improving the situation in London.
	The term polyclinic has been used in London to describe a range of models that allow primary and some secondary care services, such as diagnostics, to be available in each local community, reducing travelling time and making services more convenient for patients. In some cases, that may involve bringing services together under one roof. In other cases, as my right hon. Friend the Member for Enfield, North (Joan Ryan) mentioned—this is a specific option that is part of the London proposals—it involves having a network of GP practices linked to a hub that provides more specialist services. Both of those are available in London.
	Interestingly, in the one part of the country where polyclinics are being proposed, Conservative politicians support the proposals, as, indeed, do the public. Every local authority overview and scrutiny committee, including those that are Tory-led, backs the exciting plans to resolve NHS problems in the capital—problems that probably should have been dealt with 20 or 30 years ago.

Lynne Jones: I certainly welcome the additional investment in primary care, but whatever the problems in London, they are not the same in Birmingham. The report to the PCT on implementing the measures said that there was
	"no clear geographical area which warranted investment in an additional three partner practice"
	and no real pattern to highlight a need for the GP-led health centre to be located in one particular place. A place was chosen because accommodation was potentially available, even though there are low levels of under-doctoring there. I therefore ask my right hon. Friend please to give this money to the PCTs and to let them decide how to spend it in the interests of the people they serve.

Alan Johnson: I think that that is the Opposition's policy—give the money to the BMA and it will decide how to spend it. It is also their policy for GPs to be allowed to set up where they want to, for GPs to be allowed to open when they want to and for GPs who work in disadvantaged areas to get more money. I do not agree with that policy. I believe that when we move on from London and talk about other parts of the country, including the west midlands, my hon. Friend will agree that our proposals are the most sensible way forward.

Norman Lamb: The Secretary of State accused a Member on his own side of the House of adopting the policy of the BMA, but the hon. Member for Birmingham, Selly Oak (Lynne Jones) actually said was that she wanted to give power to the local area so that decisions could be taken locally. Surely that is what should be done, as it is local people who know what the needs are in any particular area.

Alan Johnson: That is what we are doing— [Interruption.] I am talking about what is happening in London; I will come on to the rest of the country in a minute. London has had its own analysis of problems, which have been the subject of many reports over the last 20 years. Politicians refused to implement the proposals. We are implementing the proposals, with London's support.

Tony Wright: Is it not interesting to note that the BMA—when not campaigning and producing petitions—wrote a few weeks ago to all GPs and local medical committees describing the new proposals in what it called a "factual guide"? It talked about the key differences between the health centre proposals and the polyclinic proposals; and of the polyclinic proposals it said, "mostly in London".

Alan Johnson: I have not seen that particular circular, but that is exactly what I am trying to explain. In London, there is a specific proposal about polyclinics. That is opposed by the Conservative party, despite the fact that the project has been worked up locally by people in London and has been the subject of full consultation with the public and GPs.

Clive Efford: In my constituency, we are about to rebuild a new local hospital which will be a 24/7, GP-led urgent care centre with 40 respite beds and diagnostic services that are to be brought right into the heart of our community in Eltham. The hon. Member for South Cambridgeshire (Mr. Lansley) has proposed that any vested interests in the local health economy could scupper that in the face of widespread local support for the scheme. That is not bringing the service back to local people; it is taking it away from them and putting it in the hands of vested interests.

Alan Johnson: My hon. Friend makes a very powerful point. The Minister of State, my hon. Friend the Member for Exeter (Mr. Bradshaw), will be visiting the area next week.
	Unlike the proposals for London, the 150 GP-led health centres that my Department has asked the NHS to develop across the country are not, and have never been, designed to alter the way in which existing GP services operate. The London proposals are so designed, for all the reasons that I have discussed. The proposals for the rest of the country are not seeking to change GP services at all. They are designed purely and simply to increase capacity. The average primary care trust has around 55 GP practices that will continue to provide services to their patients as they do today. In addition to those practices, each PCT will also now have a GP-led health centre, funded from ongoing additional investment, attached to which are only three conditions. No. 1 is that the centre should be in a central location; it should be accessible. No. 2 is that it should be open from 8 am to 8 pm, 365 days a year. The third is that any member of the public must be able to use the centre either to book a GP appointment or to turn up to see a GP or nurse without the need to be registered at the centre—in other words, people can continue to be registered with their local family doctor and benefit from the continuity of care that is provided.

Andrew Lansley: The Secretary of State says that those are the only requirements, but surely it is a requirement that the Department has laid down that these centres—these clinics—should register patients. By extension, therefore, patients will no longer be registered with other GP surgeries.

Alan Johnson: I just mentioned that— [Interruption.] I did. I said that the third condition allows patients to be registered or to walk in and receive GP services because they are in a more convenient location. Let us consider the logical extension of the hon. Gentleman's argument. Yes of course members of the public can decide to leave their existing surgery and register at this GP-led health centre. It is called patient choice. They are perfectly entitled to do that. What we expect is that this additional resource will be used to mix and match, as I mentioned. Most patients will want to stay with their existing GP because of the particular benefits that gives them, but they will also want to use the GP-led health service on Christmas day or on a Sunday afternoon knowing that they do not have to be registered there to use its services.

Mark Francois: rose—

Graham Stuart: rose—

Peter Bottomley: rose—

Alan Johnson: I give way to the hon. Member for Worthing, West (Peter Bottomley).

Peter Bottomley: The Secretary of State is trying to share as much information with the House as possible. Is it not true that there are two other conditions? One is that no primary care trust can say, "No, we don't want to do it." The second is that there is a rule that no existing GP-led health centre—that is to say, a wide practice—can turn itself into one of these new GP-led health centres.

Alan Johnson: It is absolutely the case that we are saying that in the interests of greater capacity, greater patient choice and the public being able to access primary care, this is not a zero-sum game. There will be a greater need to access primary care in the future, particularly with the plans that we have for prevention being as important as diagnosis and cure, and there must be one of these centres in each location.
	I have set out the three conditions. Beyond those, it is for local GPs and the PCT to discuss exactly how the service is provided.

Mark Francois: I thank the Secretary of State for his courtesy in giving way again. I suspect that hon. Members on both sides of the House would agree that many patients are naturally very loyal to their general practitioner. That being the case, does the right hon. Gentleman accept that if there were to be any attempts by financial mechanisms or otherwise to compel general practitioners to move into polyclinics against their will, that would be resisted by the GPs, very likely by their patients, and not least by local Members of Parliament as well?

Alan Johnson: I accept that point entirely. That is not part of our proposals.

Andrew George: Further to the point raised by the hon. Member for Birmingham, Selly Oak (Lynne Jones), if the Secretary of State looks at areas such as Cornwall and the Isles of Scilly, he will see that there is a geographical problem. If he is simply imposing a top-down restructuring of the type that he is describing, a single polyclinic in just one area in a place the shape and size of Cornwall will clearly have a destabilising and destructive impact. Why does he not allow that local community to design services that best meet its needs, rather than imposing this top-down, centralised restructuring? Why will he not allow the local community to design its own services and achieve the aims that I think he desires?

Alan Johnson: We have specified three conditions. The centres must be centrally located, must be open from 8 am until 8 pm seven days a week, and must allow people to use their services on a drop-in basis as well as to be registered if they wish. The money that will be invested is additional money, provided not by the local primary care trust but from the centre, to improve access throughout the country. I think that that is the right thing for a Government to do.

Harry Cohen: Members of the BMA are not the only people to comment on the proposals. The Royal College of Midwives, of which I am an honorary vice-president, tells me that it is interested in the potential of polyclinics and larger health centres to provide better midwifery services—better antenatal and post-natal care. That means, however, that the centres should provide accommodation for midwifery. Will Ministers and local NHS chiefs encourage the decision makers to provide such accommodation?

Alan Johnson: My hon. Friend has reminded me why the proposals are so exciting for London. It will be possible to provide services such as diagnostics and maternity care, and to achieve a fundamental advance in primary care in the capital. My hon. Friend has also reminded me that we should listen to the views of Age Concern. The hon. Member for South Cambridgeshire said how dreadful the new arrangements would be for elderly people. This is what Age Concern said in a briefing for today's debate:
	"For many, especially carers and those with mobility issues, the super surgery or polyclinic could be preferable to what they currently have on offer. For those without transport, it can take a whole day to get to the doctor and back, via the pharmacy. If then, they are required to visit the hospital for blood tests, x-rays or anything else, that will take them another day. There is a tentatively enthusiastic welcome to a super surgery or polyclinic that will allow them to do all these things on one day, under one roof."
	When we talk to the public and to patients, they see the attraction. Obviously they listen to the horror stories that are being peddled, because they trust their local GPs, as well they should, but when what we are proposing is contrasted with what Her Majesty's official Opposition are suggesting that we are proposing, it can be seen that what we are doing is improving primary care throughout the country.

Chris Mullin: What would my right hon. Friend say to the GPs from the local medical committee in Sunderland who came to see us last week? They welcome the extra investment, but believe that the money could be spent more efficiently if it were spent via existing doctors' surgeries. When asked why, they say that some of the previous reforms, such as independent treatment centres, have proved quite wasteful.

Alan Johnson: I would tell those GPs that this is not the only investment being made in primary care. About £500 million is going into primary care this year from one source or another. In Sunderland, as well as in my city of Hull, GPs will have their own plans, but we will ensure that nowhere in the country is there a single patient who cannot gain access to primary care seven days a week, 365 days a year, between 8 am and 8 pm. God forbid that I should make the link between Newcastle and Sunderland, but people who work in Newcastle and live in Sunderland will now be able to go to a GP-led health centre in Newcastle. This is about patient convenience and patient choice.

Howard Stoate: May I play devil's advocate, and suggest that my right hon. Friend is not going anywhere near far enough? While I support his plans for super-surgeries that will be open seven days a week—I think that that will really help patient care—my real desire is for them not just to provide GP care seven days a week but to provide visiting consultants, X-rays, physiotherapy and occupational therapy. I want patients to have access to a whole range of services that people in smaller towns and rural communities currently have to travel many miles to receive. I want the centres to provide those services so that patients will not have to travel 20, 30 or more miles to major centres to receive services that they could receive far more efficiently and cheaply in their local communities.

Mr. Deputy Speaker: Order. Before the Secretary of State replies, may I just remark that the interventions have been getting steadily longer? I ask everyone to remember that the list of Members wishing to take part in the debate is quite long.

Alan Johnson: My hon. Friend the Member for Dartford (Dr. Stoate) is right. I am concentrating on primary care because of the attack that these proposals will somehow diminish primary care. Bevan, at this Dispatch Box in 1946 as the National Health Service Act was passing through the House, saw the integration of primary and acute care as one of the fundamental principles of the creation of health centres around the country, and we have an opportunity to revisit that.

Several hon. Members: rose —

Alan Johnson: I will give way one last time, and then I shall make some progress.

Eric Illsley: We in Barnsley are looking forward to having a super-surgery—or polyclinic, or whatever it will be called. We have traditionally had too few GPs, to the point where one GP practice currently has a patient list of 8,000. Nobody can tell me that that is ideal. We are therefore quite looking forward to the extra capacity that will come with these super-surgeries.

Alan Johnson: My hon. Friend refers to Barnsley. There has been a ridiculous Conservative press release today claiming that 608 practices will close.

Andrew Lansley: It does not say that.

Alan Johnson: It is stated that the Tories claim that 608 practices may close in 58 PCTs.  [Interruption.] Well, I apologise for initially saying "will" instead of "may". Also, the procurement guidance that was "discovered" hidden away on our website was actually launched by Ministers in December at a public meeting.
	Barnsley is cited as one of the Conservatives' examples; it is said that, because there are all these GP surgeries around the area where the GP-led health centre will be placed, somehow they will all close. However, my hon. Friend the Member for Barnsley, Central (Mr. Illsley) is absolutely right. Barnsley has 49.3 GPs and 25.4 nurses per head of population and all the resultant health problems, while Cambridgeshire—the hon. Gentleman's part of the world—has 74.6 GPs and twice as many nurses per 100,000 head of population. That is why, as another major part of this proposal, we are putting 130 new GP practices in under-doctored areas, which I presume the Conservative party also opposes.  [Interruption.] Well, I am sorry, but it signed up to a petition saying that GPs should be allowed to set up where they want to set up, and if we want them to work in poorer areas, they should get more money. Not even the Brazilian Health Minister, who was talking to me the other week and who is introducing health centres in the favelas in Rio de Janeiro, was saying that the GPs who work there should get more money, but that is what the Conservatives are saying for towns such as Barnsley and Hull.

Graham Stuart: Will the Secretary of State give way?

Alan Johnson: No, I want to make some progress. I will give way to the hon. Gentleman again later, if I get a chance.

Greg Mulholland: Will the Secretary of State give way?

Alan Johnson: I will certainly give way to the hon. Gentleman shortly.
	Many PCTs are looking to provide other services in these health centres, such as diagnostics or pharmacy services. However, that is a matter to be decided locally in consultation with patients, GPs and the public. We have no plans, no intention, no desire, no aspiration and no ambition to force a specific model of primary care on GPs or patients. These new services are designed not to replace existing GP surgeries, but to provide additional access and extra choice for patients.
	Nor is this an attempt to get rid of single-practice GPs, which will continue to be an essential part of primary care, particularly in rural areas. However, there has undoubtedly been a general trend in recent years for GPs to come together to work in larger teams so that they can provide a better range of care and more integrated services. There are now more than 500 practices with nine GPs or more. This has been led and encouraged not by Government, but by GPs themselves, who increasingly find that it is more practical to work together in larger, more suitable premises, providing a greater range of integrated services.

Mike Gapes: Will the Secretary of State give way?

Alan Johnson: No, I will not give way for a while
	Therefore, having invested heavily in primary care and increased the number of staff and improved their conditions, the Government now propose to expand primary care capacity, including in the 25 per cent. of PCTs with the poorest GP provision, thereby addressing a major cause of health inequalities.
	What have Her Majesty's official Opposition got to say? Last week, they claimed that there was a £1.6 billion black hole in our plans for GP-led health centres. I note that that ludicrous claim is missing from the catalogue of ludicrous claims masquerading as a motion for today's debate. Yet again, they mistakenly assume that what has been proposed for London will be transposed to the rest of the country, and there will be 25 GPs in each of the new health centres—in actual fact, the expected number is five not 25.

Greg Mulholland: I think the Secretary of State gave a rather one-sided view of the Age Concern briefing that he mentioned. Does he acknowledge that older people have real concerns about these plans, particularly because, as we know, they are most reliant on family doctor services? There are real concerns that the relationship will be lost. There are also concerns about access during the day; people hope that the extended hours will not mean fewer opportunities to see family doctors during the day, because they are the sort of times on which older people are particularly reliant.

Alan Johnson: The hon. Gentleman is right to say that the elderly, who use health services more and, as Age Concern points out in the briefing, use primary care services much more, would be worried by any indication that their GP services were to be diminished. As Age Concern points out, the advantage of the polyclinic and the health centre for elderly people is that even if they have to go a little further to get to the polyclinic, they do not have then to go somewhere else to go to the pharmacy, to go somewhere else to get diagnostics and to go to the hospital for other services. That is a very important point.
	Incidentally, we have been absolutely stringent in saying that increased access, which the Minister of State, Department of Health, my hon. Friend the Member for Exeter (Mr. Bradshaw) has mentioned has now reached 21 per cent. across the country—that is an 11 per cent. rise since we introduced the policy—must not be at the expense of existing hours. The pay that goes to GPs is only for their giving additional hours; it is not for putting in a Saturday morning and taking away a Thursday afternoon. The hon. Member for Leeds, North-West (Greg Mulholland) is right to raise the point.

Maria Miller: Perhaps the Secretary of State can clarify something for me. He is at pains to say that his proposals do not aim to replace GPs' surgeries, yet the proposal put forward by the Hampshire PCT to locate a polyclinic—or whatever he wants to call it—in my constituency talks about building
	"capacity to absorb a growing population."
	That sounds to me as if the polyclinic is replacing the need to build new surgeries when new houses are built.

Alan Johnson: It sounds to me that building capacity to absorb a growing population is absolutely right; this new service is to deal with greater capacity, so well done Hampshire.

Peter Atkinson: rose—

Alan Johnson: I am not going to give way.
	The allegation is made by the Conservative party that every one of these GP-led centres will have 25 GPs, and that is wrong, because we expect them to have, on average, about five new GPs. That rather silly misrepresentation is less pernicious than the way in which many patients are being deliberately misled by some in the profession about what our proposals to improve primary care actually mean.
	I have here a leaflet produced by a group of GPs on Teesside entitled "Save our Surgeries". It has an NHS logo on it, when it should not have, it contains no address to which to write and it makes several unsubstantiated claims about what our proposals will mean. It is, by no means, an isolated leaflet; such leaflets are going right across the country. It says:
	"This initiative will be the first stage in dismantling of traditional general practice in this country."
	That is nonsense, because we are actually providing new investment and additional capacity.
	The leaflet also states:
	"You will have to de-register from your local surgery in order to register and be seen in a new one."
	People will not have to do so, although, of course, anyone who chooses to change their GP, as is their right, will have to register with a new practice. That is the case for any patient now who chooses to change practice, but the same will not be true for those who use the new GP-led health centres. As I have explained, patients do not have to leave their existing GP to gain access to the new service.
	Here is another one; the leaflet also states:
	"This funding is only for a very short time. When it runs out, the PCT will have to use other funding to continue the new services."
	That is not true. We have confirmed that it will be recurrent funding for primary care trusts. Finally, it states:
	"The proposals will eventually force doctors to leave traditional general practices and work for private big companies like Tesco or Virgin...Doctors who work in these practices will have to follow company policy and protocols regarding prescribing expensive drugs and making referrals to hospitals."
	This borders on hysteria. In the first instance, we expect many of the new contracts to go to GP-led consortiums, not private companies, and any GP practice, whoever runs it, has a professional duty to provide the best possible care for its patients and will already work to sensible protocols on prescribing and referral. In fact, Virgin has made it clear that it is not interested and will not even be bidding for these new practices. It will seek to get GPs—who are already, I remind hon. Members, in the private sector—to come into consortiums with it, and it will provide the building. That is nothing to do with the Government or the 150 new GP-led centres.

Graham Stuart: Will the Secretary of State give way?

Alan Johnson: No, I will not.
	Such scurrilous leaflets ignore or patronise the central player in this debate: the patient. While the vast majority of GP practices provide an excellent service, it must be acknowledged that many patients cannot access the services they need and that there is a very real need to improve the quality of primary care in some parts of the country, especially in London.
	We have many examples of patients being dragooned into signing the BMA's petition, but when patients understand our proposals, they realise that we will not be taking away their GP services and that the relationship between the family doctor and the GP is sacrosanct and will be protected by this Government.
	The Government believe that adding more than 270 new GP practices and GP-led health centres across the country, with the majority in under-doctored areas—some of which have been under-doctored for the past 60 years—will add extra capacity, provide more convenience and choice for patients, and allow the expansion of more preventive work such as vascular checks to proceed successfully. As we will not be removing existing GP surgeries, the time for the Opposition to criticise these proposals will be when and if these new facilities remain empty and unused once they have been established. I confidently predict that that will not be the outcome, and that historians of the health service will look back on this peculiar spat as the time when producer capture killed off the little credibility that the Conservatives ever had on health issues. I commend the amendment to the House.

Norman Lamb: It is surely a spectacular achievement by the Government to have taken a concept that is clearly worthy of consideration and development and, in the space of nine short months, turned so many people against it. The reason for that is the central imposition from Whitehall, which will require every PCT to introduce a GP-led health centre.
	The Secretary of State draws a distinction between GP-led health centres and polyclinics, but the King's Fund—which is entirely independent of the BMA—says that they involve a model of care that is not dissimilar. GP-led health centres are, at the very least, embryonic polyclinics. They look to most independent observers very much like the same thing. As the hon. Member for Birmingham, Selly Oak (Lynne Jones) and my hon. Friend the Member for St. Ives (Andrew George), who is no longer in his place, made clear, surely the decisions should be made by local commissioners, who are accountable to the communities they serve.
	The frustrating aspect is that this all started so well. In July last year, the Secretary of State announced the Darzi review. He said:
	"The review, the first of its kind, will directly engage patients, NHS staff and the public. I have written...to all NHS staff to explain the importance of this new approach. The success of the review will depend on gaining access to those relationships and stimulating a range of lively, local, provocative debates. Public services cannot be transformed by going against the grain of public service, or without support from the professionals who know the NHS best."
	That was the stated ambition at the start of the process, but three short months later, when the interim Darzi report came out, it announced the 152 GP-led health centres, one for every PCT. Was that really the outcome of that great conversation with the NHS, or was it the imposition of a blueprint that had already been determined long before the launch of the review?

Lee Scott: Does the hon. Gentleman share my concerns about the fact that Lord Darzi said in his report that many polyclinics would take the place of the care provision formerly provided by district general hospitals? Does he agree that that would be a detrimental step? We have all been fighting to save our district general hospitals, and anything that threatens them will be of great concern.

Norman Lamb: That might be a concern, but my argument is that these new mechanisms for delivering care should be piloted. They should be tried in various parts of the country so that we can learn the lessons, both positive and negative, and see what the implications are for district general hospitals and community hospitals. We ought to be developing a lot of these services in local community hospitals, which often serve very rural areas. For many communities, that would be a much better way forward than the Government's proposals.
	The Secretary of State, who has left the Chamber remarkably quickly, claimed that this was not a central imposition, but it is. The operating framework for the NHS for 2008-09 states that
	"all PCTs will complete procurements...for new GP-led health centres"
	within this year. What a stitch-up—a centrally imposed direction from Whitehall that must be carried out within such a short time.
	One would have hoped that the Department and Ministers might have learned lessons from the debacle that was the Medical Training Application Service and from the whole business of modernising medical careers. We saw the consequences of imposing an entirely new system across the whole country, without proper piloting, and it ended in disaster, causing many problems for junior doctors. Did the Government learn their lesson from that gross error? No, they did not.
	Here we are again, imposing a system from the centre despite all the evidence, which I shall come on to, from the King's Fund and many others, which ought to be enough to make the Government stop and think, and learn lessons before proceeding further. In future years, this case will provide us with yet another perfect case study of how rushed central imposition fails, with the waste of resources that always happens when attempts are made to impose a measure from Whitehall, with the failure to develop policy based on evidence, and, critically, with the alienation of professionals and communities.
	Let me deal with the subject of the alienation of professionals. The Government have decided to pick a fight with the BMA, and with GPs in general. They quickly dismiss the BMA, accusing it of being luddite and resistant to any change, and saying that it always has been like that and always will be. That view results in the Government closing their mind to legitimate concerns from many doctors about the implications of the proposals. It also closes their mind to the risks of undermining what is already very good in our primary care system. Primary care in this country is the envy of much of the rest of the world. We must never be complacent about the need to improve primary care when it fails, but there is a real risk that the proposals will undermine much of what is so good about the system that we have.
	Alienating communities is not the way to empower communities or local commissioners. The primary care trust in Birmingham mentioned by the hon. Member for Birmingham, Selly Oak might well have its own plans about how it wants to develop services in that community. In my county of Norfolk, the primary care trust has not even finished a review of its estate since it was created in the autumn of 2006, yet this change is being forced on it.
	These decisions should surely be made locally, and should be based on what works best in the area. They should be based on what services are being developed to provide the services talked about in the proposal—such as the community hospitals, which are so critical in serving rural areas. They should be based on the quality of primary care. It is variable; surely that points to a need for local solutions, rather than having Whitehall simply impose its proposals. Surely local commissioners should make such decisions. What are the important principles that should apply, and what evidence is there that existing provision is failing? What evidence is there that polyclinics will provide solutions to any of the failures that we identify?
	The principles behind the proposal are important. First, clearly there are real issues to be addressed in connection with the concept of breaking down the divide between primary and secondary care. The case for providing care closer to home is an important principle, as is the quality of care provided to the patient. As for whether there is a need to improve what we already have, as I have said, we must not be complacent. There is a divide between primary and secondary care, and we should consider all ways of reducing that divide, to ensure that there are better working arrangements between consultants in hospitals and GPs working in the community.
	The quality of primary care is generally, but not universally, excellent. The Royal College of General Practitioners is aware of that; it recognises the variability of care across the country, and the fact that in deprived areas there are fewer GPs. There are concerns that some single-GP practices do not provide the quality of care available elsewhere. Some are very good, but others do not offer care of a sufficient quality. There are financial incentives that encourage GPs to work in the leafy suburbs, but not to work—or stay—in the poorest communities. Those financial incentives need to change.
	There are also concerns about the patient experience. The Secretary of State made the point that if a person has to visit a GP, then a pharmacy elsewhere, and then a hospital for a further check-up, perhaps after an operation, they may make many long journeys. That can be extremely onerous for the elderly and people who live in rural areas. At the beginning of the week, I spoke to a constituent who described making a 60-mile round trip to the acute hospital in Norwich for what turned out to be a two-minute check-up appointment following an operation. None of us can be happy with that situation, so we must have open minds and be willing to consider ways of improving the patient experience.
	It is worth while considering new models of care, looking at what works in other countries, and trying to learn the lessons. Last summer, I visited the Arches health centre in a poor, inner-city part of Belfast. It is, in essence, a polyclinic. It brings together health and social care, and there is a citizens advice bureau in there, too. To all intents and purposes, it looked like an incredibly impressive facility, so I am certainly not dismissive of the concept's potential to work in certain defined conditions, but when the King's Fund looked at the evidence, it raised serious concerns.
	The King's Fund first looked at other countries. There is some bizarre cross-dressing going on; it talked about the original concept coming from the Soviet Union and being developed in many eastern European countries that were part of the Soviet bloc, yet those countries are now moving away from that model, and towards a much more open primary care market. Meanwhile the United States, Germany and Canada are very much moving in the direction of the polyclinic model. As two groups of countries are moving in diametrically opposite directions, the changing enthusiasm for polyclinics surely ought to make us wary.
	The King's Fund also warns that what might look very attractive and work effectively in the States or Germany cannot be translated to this country. It makes the point that there are far more doctors per 1,000 people in Germany, for example, than in this country. So caution is required about simply adopting something that looks good elsewhere.
	The King's Fund clearly recognised the potential for such new concepts of delivering care, but it found no systematic evaluations of polyclinic models in other countries. The Government, however, appear determined to proceed without that evidential base. The King's Fund had real concerns about what it saw overseas. It saw that, in many cases, the fact that professionals were working together under one roof did not automatically lead to integrated care; it saw a lack of integration between polyclinics and hospitals. It raised concerns about a lack of continuity of care, whereby the patient did not see the same doctor every time. That is one of the issues that cause elderly people a lot of concern.
	The King's Fund found concerns about a decline in professional motivation and development, where consultants who might previously have been based in hospital centres of excellence end up in more remote settings away from professional colleagues.
	Bizarrely, given the Government's claims, the King's Fund identified a lack of patient choice. Given some of the concerns that have been raised by the BMA and others about the ultimate position with small GP practices closing, the result could be that people in a local area end up with less choice about their primary care centre. They might have no choice but to go to the local polyclinic. That looks very likely to be the case in London.
	The King's Fund also looked specifically at the local improvement finance trust schemes already operating in this country. It specifically examined 12 LIFT schemes that it considered bore all the hallmarks of the polyclinic model that the Government seek to pursue. It said:
	"If anything were to demonstrate the benefits of the polyclinic model in England, it should in theory be evident in LIFT schemes."
	What did the King's Fund find? Its conclusions should worry the Government. It found little evidence of innovation in this country's existing polyclinic model. It found that local authority social services, which were supposed to be integral to those centres, had "fallen by the wayside" and were not continuing to participate in them because of tight local funding streams.
	Crucially, the King's Fund found a lack of clarity about responsibility for strategic development—no one in charge, determining the strategic development of those centres. It found a lack of clarity about who was responsible for overall clinical governance in those facilities. Surely that should disturb the Government. It found that payment by results—the Government's mechanism for funding care, which is a blunt instrument—is causing acute hospitals to have their funding streams undermined where such centres exist, because the polyclinics do the more routine procedures, thus leaving the acute hospitals to do the more expensive procedures, while receiving the same tariff. They are losing income for the simple procedures and receiving too low a tariff for the more complex procedures. All that is swept aside in the Government's determination to rush headlong down this route.
	The King's Fund also found that none of the 12 existing schemes demonstrated savings or improvements in costs compared with previous models of care. They had struggled to persuade GPs to relocate, and had been developed because of a political imperative to introduce them, rather than being based on patient need. The report raised the specific fear that polyclinics would, in effect, become white elephants. It also noted the concern about access. It drew specific attention to the fact that if people have to travel further and for a longer time to their primary care centre—particularly in the more deprived communities, where people might not have access to cars—they are less likely to use that facility. Surely, again, that should be a concern in London, given the proposals that the Government are intent on pursuing.
	When the King's Fund examined the 12 existing cases, it identified a failure to shift any care from remote acute hospitals to polyclinic settings. It is essential to secure local leadership and a shared ambition, which is usually lacking when a model is imposed on an area by Whitehall.
	The King's Fund has stated that, critically, the Government have not answered the question about who will lead on either strategic direction or clinical governance. Until the Government clearly indicate their intentions on centrally imposed GP-led health centres, there will be massive concern that the fears identified by the King's Fund in the existing centres will be realised right across the country, because we have not learned the lessons from the pilots. Foreign evidence also points to the central importance of leadership in such centres. The existing LIFT schemes and the foreign experience should be enough to persuade the Government to pause for thought.
	My plea to the Government is to develop pilots with proper investment. The King's Fund has stated that the focus is often on simply creating the building within which services are provided, without investing in change management, which involves changing services and the way in which patients are treated. We should develop those models, extend the evidence base, sort out the question of leadership and explore the range of models, which include hub and spoke, and locating all GPs in the same building.

Ben Bradshaw: The hon. Gentleman is discussing pilots and polyclinics. He may be interested to know, if he does not know already, that the only part of the country that currently proposes to develop polyclinics is London, where 10 pilots have been proposed.

Norman Lamb: As I have said, the King's Fund has highlighted the fact that GP-led health centres across the country have all the hallmarks of polyclinics.

Robert Goodwill: I have the minutes of the North Yorkshire and York primary care trust clinical executive meeting in February, which considered a proposal for a polyclinic in Scarborough. The PCT thinks that it is going to have a polyclinic, even if the Minister does not.

Norman Lamb: I am grateful to the hon. Gentleman for that intervention. Everyone outside this place uses the terms interchangeably—for example, the King's Fund, the independent research body, uses the terms interchangeably. Everybody understands that what is happening is the introduction of something that looks very similar to a polyclinic: it may be embryonic, if that is the right way to describe it, but it has many of the characteristics of what the Government describe as a polyclinic.
	We should watch the evidence develop and allow experiments with community hospitals to develop services in rural areas. We should listen to the warnings from the King's Fund and many others rather than the warnings from the BMA. Many independent bodies have expressed concern and oppose the central imposition of a new model of primary care. Even at this late stage, given all the evidence out there, the Government should make it clear to PCTs and to strategic health authorities which quietly do the Government's bidding, that PCTs are free to say that they will not introduce polyclinics, that PCTs can develop their own mechanisms for delivering care within the community, and that PCTs will not be disadvantaged as a result of taking such decisions. We should learn the lessons first, and allow locally accountable commissioners to make such decisions.

Several hon. Members: rose —

Mr. Deputy Speaker: Order. Mr. Speaker placed a time limit of 12 minutes on Back-Bench speeches in this debate. It is now apparent that if that is maintained throughout the period, not everyone will be able to take part. I propose that the first two such speeches will be subject to the 12-minute limit, and then I shall review the situation in light of how much time we have left at that stage.

Frank Dobson: I am in no position to comment on the appropriateness or otherwise of polyclinics—or whatever the Government's term is in relation to other parts of the country. Polyclinics may turn out to be useful, successful and helpful, but I am here to speak up on behalf of patients and professionals in my constituency who are expressing a great deal of concern about our primary care trust's proposals. Most people in the locality approach the issue with great distrust, because they feel that our area has been used as a testing ground and my constituents as guinea pigs in new approaches to general practice and primary care.
	Until now, our area has been well served with effective and very popular GP services, but it is being subjected to changes that, from the point of view of local people, are unasked for and untried. Recently, three GP practices were privatised—there is no other way to describe it. Three popular practices were required to bid to continue their existence. They met all the quality requirements, and in the assessment they did better than the private sector bidder on all of them, but the private sector bidder put in a lower bid in terms of costs. The bid was never quite clear, because when people inquired into how the situation had come about, they were told that the matter was commercial and in confidence.
	UnitedHealthcare, a subsidiary of an American outfit, secured the contract. I expected—perhaps rather cynically—that it would put on an absolutely wondrous show in the three practices that it had taken over, so that they would serve as loss leaders and as an example of what a good job it could do. My cynicism was not justified, because although a man called Neil Bentley from the CBI has declared them to be a success, he obviously lives in an evidence-free zone. Since the new company took over, appointment times for each patient have been reduced from 15 minutes to 10. If the visit or appointment is unscheduled, people get only 5 minutes and are told that they can talk about only one problem, even if they have more. The new company has not complied with the extra opening hours that the contract specified, and which it undertook to deliver. It closed a baby clinic and then had to reopen it in response to a public outcry. There are rumours—although they are denied—that the company is in the process of going back to the primary care trust to ask for more money.
	That is what has been happening in my constituency, and now we have proposals for polyclinics. These, we are told, will provide community-based diagnostics. There are apparently three proposals for polyclinics in my constituency, and as part of the move to community-based diagnostics, one will be at University College London hospital and another will be at the Royal Free hospital, so we will actually have hospital-based diagnostics and—this will be a novelty—hospital-based community and GP services. Originally, polyclinics were to be targeted at under-doctored areas and populations, which might be worth while if it were the only way to secure the extra doctors and better services required to meet people's needs. But those needs vary from place to place, depending on the geography and on the nature of the population. I have always believed in horses for courses, but I do not think that the Government do. In London, it is certainly not horses for courses but "Thou shalt have a polyclinic." I also believe that it would be a good idea for these things to be tried out in pilot schemes in various parts of the country.
	I must remind Ministers that, generally speaking, GP services are very cost-effective, particularly in their role as gatekeeper for the rest of the national health service. I am sure that the Minister would have to confirm that when he talks to Health Ministers from abroad they are envious of the impact of GP services on keeping down costs. It looks, from such evidence as is available, as though where polyclinics, or something like them, exist, more investigations and tests are prescribed, often wastefully, as in the United States—perhaps less so in Germany—and more people are referred to hospital as in-patients. Both those developments may be a good thing from the point of view of patients, but they may also be on the excessive side.
	I have some questions, to which I have not managed to get answers, about the proposed polyclinic at University College hospital. It appears that that scheme will involve everybody who goes there for GP services, as well as everybody who goes to accident and emergency and can walk into the place, as opposed to arriving by ambulance. In effect, far from there being a shift to community services, we are moving towards provision being increasingly concentrated in the hospital. Will the doctors there be able to refer people to other hospitals instead of University College hospital, where the polyclinic will be located?
	Then there is the question of the impact on the area's existing GP services, which are convenient and familiar—two things that appeal particularly to older people, disabled people and families with children. It is also the case that nearly everyone looks for some continuity of care by seeing the same doctor, if at all possible.
	Ministers have said that no one will be forced to join a polyclinic, but when the companies' contracts come up for renewal, will they get them renewed, will the same terms be available to them, and, more importantly, will they be entitled to apply to some of the practices outside the polyclinic? That is not clear at the moment.
	That brings me to the question of who will own the polyclinic. Will it be a private sector outfit? Will UnitedHealthcare, which has already taken over the three GP practices in the area, be able to bid for and take over the polyclinic? If so, that will be despite the fact that its owners have been indicted for fraud and every form of swindling of taxpayers, patients and doctors in the United States. If it gets the polyclinic contract, will it also get the out-of-hours contract, for which it is believed to be bidding? If so, we would end up with a US company having something approaching a local monopoly in part of my area. I remind Ministers that the first priority and statutory duty of the people running a private sector company is to put the interests and needs of shareholders first. It is not just me who says that. Mr. David Worskett, director of the self-styled NHS Partners Network, which is in the private sector, has said:
	"The independent sector has to protect shareholders' interests".
	This company, as an American company, believes in turning diseases into a commodity; that is how it has made its money over the years.
	Camden primary care trust is already putting a massive effort into promoting polyclinics at University College hospital and the Royal Free hospital, but it is not putting the same effort into two practices in Kentish Town that have put themselves forward as a possible polyclinic. They have not had the same level of involvement from officialdom, yet they have a fine track record. They have been providing primary care. They have arranged for consultants to come out and see their patients in their practices. They have run drug and alcohol clinics. They have helped people suffering from drug and alcohol problems to find employment. They have provided psychological medicine. They have provided help for children and families. Social workers have operated from their premises, and so have people from the voluntary sector. These people have a proven commitment and competence, and to develop what they are doing would be the sort of organic development to which the Government should be committed—going with the grain, from the point of view of patients and professionals.
	The London polyclinic proposals are not like that. The Secretary of State and the London health lot say that the proposals are led by the NHS in London, not the Government. I do not understand that. Professor Ara Darzi, who is a most distinguished surgeon and a highly intelligent and charming man, put forward the polyclinic proposals for London. He is a Minister in this Government. Mr. Paul Corrigan, who used to work at Downing street, is the London director of strategy and commissioning in London, and the benighted Lord Warner is chair of the provider agency in London, following his departure from office as a Minister just before all the trouble arose over the problems of junior doctors. Let us assume for a minute that there is no Government influence in the matter. That means that the strategic health authority, which is not accountable to anyone, and the primary care trust, which is not accountable to anyone, are taking decisions. In the end, however, Ministers are responsible, and I believe that they ought to take a step back.
	The next thing I have to say is something conservative: remember the cost of change. The process of change is immensely costly, in terms of money and the amount of time and effort that people have to put into the process of change. I believe that Ministers—

Mr. Deputy Speaker: Order. I have to curtail the right hon. Gentleman at that point.

Robert Goodwill: My constituents in Scarborough are perplexed, confused and angered by the proposals. If the Minister comes to Scarborough, as I hope he will very soon, to talk to people there, he will hear that they want more money to be spent on a number of areas in the health service, such as dentistry.
	Scarborough hit the headlines two or three years ago when we had queues going round the block, reminiscent of the Soviet Union bread queues, when it was rumoured that an NHS dentistry practice was opening up. People are very concerned about out-of-hours services, and four years ago the local primary care trust upset the applecart when, by putting the out-of-hours service out to tender, local GPs who were covering those services and providing cover at the local community hospital found that they did not get the contract for such services in the countryside, which meant that they could not also cover the hospital. A lot of money was wasted in one case, when dentists from Germany were brought, at £700 a night for 10 nights at a time, to provide cover.
	Whitby hospital in the north of my constituency is being subjected to death by a thousand cuts, according to many in that area. Services have been reduced. The accident and emergency service is under siege because of the list of incidents that ambulance drivers are told they must not take to Whitby—only the most minor of injuries and illnesses are dealt with there. Maternity is currently under review at Whitby because we are told there is no demand for maternity services. That could be something to do with the fact that maternity is open only from 9 until 5. The health service is under siege in my constituency, and the Government are coming up with a solution to a problem that many people do not see.
	I would like to share with the House a letter that I recently received from one of my constituents, Mary Thompson. She writes:
	"The last time I wrote to an M.P., it was to complain to Lawrie Quinn"—
	my predecessor—
	"about the lack of N.H.S. dentists in Scarborough. The situation has got worse since then, but I must keep trying.
	This time, it is still the N.H.S., but I would like to tell you about some of my husband Eric's experiences since being diagnosed with bowel cancer four years ago.
	After two major operations, chemotherapy and radiotherapy, the cancer returned and Eric was referred to the Leeds General Infirmary by Scarborough Hospital, who were unable to do any more for him. We saw a Mr. Sagar who arranged for several tests, including a PET scan in London"—
	250 miles away—
	"for which we had to arrange and pay for transport ourselves—no mean feat for someone who had great difficulty sitting comfortably due to the nature of his illness. Eric's operation was arranged for August 18th, the long delay"
	of five months
	"in part due to the fact that a urology team had to be on stand-by as well as the bowel team, and a high dependency bed was also needed as it was not certain that he would even stand the surgery, so big an operation was planned. On the day, Eric was gowned and ready for theatre when Mr. Sagar arrived to see him, extremely angry, to say that the operation would have to be cancelled, because of the two high dependency beds available to him, one had been given to a road accident victim, and the other was needed for the person whose operation was before Eric's—his need was deemed the greatest.
	Apparently there is a shortage of high dependency beds due to government cuts. Eric was allowed to go home for the weekend, but had to return on the Monday to keep his bed."
	That is a 120-mile round trip. The letter continues:
	"The operation now took place the following Thursday, and though successful, was incomplete as he was left with two nephrostomies (tubes leading directly out of his back from his kidneys, emptying into two bags attached to his legs) instead of the urostomy which had been planned. We were never told whether this was due to the postponement of the operation and consequent changes of staff.
	After going home, Eric became very ill on September 21st and our G.P. arranged for an ambulance to take him to the A&E at Scarborough Hospital. We waited two hours, then our son arrived, so we cancelled the ambulance and got Eric to the hospital in his car, where we had the usual long wait in A&E. Eric was unable to stand and found the chairs there very uncomfortable, given his condition. I remarked to a nurse that we had been waiting a long time and she snapped back 'Everyone has to wait—it's part of the system'"—

Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Gentleman, but he is going into considerable detail on a matter that appears to lie outside the terms of the motion and the amendment, which are about primary care as opposed to the secondary sector, to which he is referring. May I suggest that he try to move back pretty quickly to the primary care sector?

Robert Goodwill: I thank you for that guidance, Mr. Deputy Speaker. I am trying to show where we need better spending in the health service. Mrs. Thompson closes her letter by saying that better medical facilities are needed and that she does not know where all the money is being spent.
	In Scarborough hospital, we need money to be spent on the deep clean which has still not been delivered. Last year, 600 jobs were going to be cut. I hope that the Minister will visit Scarborough and see where we need to spend money. We clearly do not need to spend it on a polyclinic.
	In February, the PCT was told that there had to be a polyclinic somewhere in Yorkshire, and several sites were considered, including Selby and York, before it was decided that Scarborough would be the place for it. People in Scarborough feel strongly that they do not want it; they want services through their GP. Our local newspaper asked people on the streets what they thought. Mrs. Marcia Waddington said:
	"I know change has to happen but I think change is not always for the better. This Government might think bigger is better but sometimes it is not."
	He husband added:
	"The older generation especially prefer to see a GP who knows them and their background. It just wouldn't be the same."
	A lady from Colescliffe road said:
	"I don't want to go to a super surgery. I want to go to my doctor's surgery. We don't need these types of surgeries. I know my doctors and like them."
	I pay tribute to Mr. John Palethorpe, who led the campaign last year to save services at Scarborough hospital and has been leading the campaign this week to save our GP services. The relationship between the patient and the GP is the most valuable part of our health service. The proposal to parachute a polyclinic into Scarborough would jeopardise that important relationship. We already have a facility in Scarborough where a variety of services are available, but which is underfunded, namely Scarborough hospital. If the Minister has £1 million in his back pocket, may I suggest that he invest it in Scarborough hospital, rather than providing us with a polyclinic that neither the GPs nor the patients want?
	Will the Minister clarify the situation when he winds up the debate? We were told that there would be a single unit in the middle of the old town in Scarborough, but only yesterday there was a report in the  Scarborough Evening News of a meeting held on Saturday about the new super-surgery, at which the head of commissioning, Jane Marshall, said that
	"the plans would likely encompass services in a number of locations rather than an all-under-one-roof service."
	The Secretary of State was talking about clinics in one place. How will he deliver on the improvements that he claims he can, if services are provided in a number of locations? Will all those locations be open from 8 am to 8 pm, seven days a week, or is the local primary care trust, realising that what is proposed is not wanted, trying to come up with imaginative and innovative ways to spend the money?
	The polyclinic in Scarborough is not wanted by patients or GPs. If the Minister has the money to invest in the health service in Scarborough, there are a number of areas, including dentistry, Whitby hospital and Scarborough hospital, where it could be better spent.

Several hon. Members: rose —

Mr. Deputy Speaker: Order. In order to be fair to the seven hon. Members who are seeking to take part in the debate, I am making the time limit nine minutes. That should, I hope, meet everyone's needs.

Lynne Jones: The debate has shown that needs differ throughout the country. I cannot understand why the Government are not standing by their rhetoric that all change should be locally led. It is quite clear that change is not locally led, except in the sense that there is a lot of anticipatory compliance in the modern NHS.
	When I started receiving communications from my local GPs and constituents about the new provision, which they felt threatened their existing surgeries, I immediately contacted the PCT to find out what it was all about. On the surface, providing additional services seemed an excellent idea, so I got hold of the PCT report about the proposal. As I mentioned in my intervention on the Secretary of State, it is quite clear that the PCT is not leading the proposals. Indeed, when I asked the PCT whether the proposal was one that it would chose to spend the additional resources on, in order to improve health inequalities in south Birmingham, it was clear that it was not.
	We do not have an easily identifiable gap in services. The PCT proposes to locate the new 8 am to 8 pm health centre in the Selly Oak part of my constituency, for two reasons. First, it is on a main road. Secondly, because of the short time scale—the PCT has to have the centre up and running by 1 April 2009, a date that it told me was non-negotiable—the PCT is scrabbling around trying to find suitable accommodation and will have to choose a location where it has existing buildings. That is the reason for the one location. The need for a particular building is also the reason for the other location, in another part of my constituency.
	On the Bristol road in Selly Oak, where the health centre is proposed, there is a new £2 million investment by one of the local GP practices, which is set to double its GP list—it is expecting to take on an additional 4,000 patients. The development has been five years in the making, with full support from the PCT, and will provide services in addition to GP services. This GP approached me many years ago; he was concerned about the lack of services to combat osteoporosis, which is common in women, and he remains concerned about ill health prevention and equality of access to services.
	In King's Heath, the currently favoured location for the GP-led practice, a new health centre has just opened, providing full GP and other services and an associated new pharmacy. The location of the proposed new practice is near at least three other GP practices. I know that very well, because it is where I live.

Norman Lamb: Is not the approach that the hon. Lady is describing precisely what ends up demoralising local health workers and clinicians so much, because all the things they see developing end up getting undermined by something imposed from above?

Lynne Jones: That is absolutely right. Obviously, the PCT would not earn brownie points if it failed to go along with these proposals.
	When I heard about these proposals, I immediately thought, "Why should these new services threaten existing services?", but it is quite clear that the health centre is expected to take on 6,000 patients, as is the GP-led centre. Yes, they will also take people who are not registered and there is certainly a need for the proposed services, but the GPs say they would be delighted to provide those services if only there were an opportunity for them to expand existing provision. It seems, however, that the rules say that the premises have to be completely new, so they are not in accordance with the idea of expanding existing GP provision.
	When I started to investigate these issues I was worried, so I went back to the Darzi interim report and tried to find the logic behind these proposals. I found that Darzi had noted that life expectancy was lower in areas where there were fewer GPs per head of population. That may well be the case, but I am not sure that the conclusion follows—that the way to deal with the problem is to develop 150 GP-led centres and to provide new GP practices in areas where there are health inequalities. It is not exactly logical to deduce that that is the way to deal with the problem. I read the report, but I could not understand the thinking that led Lord Darzi to decide that this was the solution to under-doctoring. I certainly could not understand why he should view it as a blueprint to be applied across all PCTs. The under-doctoring in my constituency, for example, is not particularly great and it is spread out—there is no single location where there is a problem.
	It seems to me that the Government should stop portraying the debate over these issues in terms of the BMA and the Tory party being opposed to genuine locally led improvements in service. That is not the case. Two of the GPs who contacted me about this issue are members of the Labour party and they are actively interested in improving services to their patients and reducing inequalities. One made a submission to the Select Committee on Health and is active in the Socialist Health Association. These are not people who naturally look to the Conservative party to champion their cause. They are very worried—and their worries were confirmed by a conversation I had with the lead officer at the PCT—that this is just an excuse to bring in the private sector and provide competition, which is seen as the way to make GPs buck up their ideas and improve their services. I do not think that the GPs in my area need that kind of competition. They want improvements in service. They put in bids to expand their practices. They are outraged because they were told a year or two ago that they should cease providing Saturday morning services and are now being told that that is what they must provide.

John Leech: Does the hon. Lady agree that there is already competition among GPs? If people do not like their local GP, there are usually plenty of others in the area to choose from.

Lynne Jones: Yes. A couple of my constituents recently changed practice. One of them has mental health problems and, having talked to the new GP, felt that he was more sympathetic to her. GPs are even willing to engage with patients when they want to find out whether it would be a good idea to move to their practice. That is already possible.
	Many GPs would like to provide the proposed services, but they say that there is no level playing field. The new provision is being procured through the standard procedure, which gives large alternative provider medical services an administrative advantage. Those services are bidding for other contracts and are set up for that kind of work, which is not the case for GPs. Some GPs who have expressed an interest in bidding for the services were given 24 hours' notice of a bidder event day. Most of those who have looked into the possibility of tendering do not believe that they are in a position to do so. It would divert their attention from what they should be doing, which is providing high-quality services for their patients.
	I ask the Government to look seriously at the criticisms made today, particularly by Labour Members. We believe that the Government have much to be proud of in terms of developments in the health service. There is no doubt that health services have improved dramatically since 1997. We have 5,000 more GPs, and GPs now have more time to spend with their patients. However, the Government should not simply dismiss the concerns of GPs because they think that they are being oppositionist for opposition's sake. There are many good reasons why the BMA in general and GPs in my constituency are concerned about the proposals. They believe that they will destabilise existing services. How will a practice that is expanding, taking on an additional 4,000 patients, continue when there is going to be a new health centre over the road, potentially taking on 6,000 patients? It will have to take on additional patients if it is to continue to receive funding beyond the five-year allocation. In the end, the money will be allocated to the general pot and there will be no specific allocation for the proposed services.
	I urge my hon. Friend—

Mr. Deputy Speaker: Order.

Maria Miller: We are two hours into the debate and we have yet to hear anyone speak in support of the Government's policies on polyclinics. I am sure that the Whips are going around trying to find someone who will speak up in favour of what the Government are talking about.
	It is a particular pleasure to follow the hon. Member for Birmingham, Selly Oak (Lynne Jones). I could not agree more that all the change in health care should be locally led. I am sure that the Minister will have paid close attention to the right hon. Member for Holborn and St. Pancras (Frank Dobson) who, after all, was the Government's first Health Secretary and talks a great deal of common sense on these matters.
	There is nothing more important than primary health care because it is the primary interface that patients have with the health care service. That is particularly so for older residents and the very young in our communities. GP surgeries are often the last community-based service that is available not just in villages but in the suburbs. It is a service that gives people access to the NHS at the heart of their communities, close to their homes, and its future should be driven and shaped by those communities to ensure that it meets their needs. Lord Darzi made great play of that recently when he visited the constituency next to mine, just outside Basingstoke, to talk about the future of polyclinics or GP-led health centres.
	The problem we face in my constituency is that the Government have great house building targets for Basingstoke—with which many local people, including me, do not agree—that are not matched by a similar expansion of local surgeries, including GPs' surgeries. About 1,000 houses a year are being built, there has been a 13 per cent. increase in the number of babies born in our local hospital, and the fastest-growing group of people in my constituency are those aged 65 and over: the pensioners of north Hampshire. However, we are seeing a real lack of support for the development of those important primary health care services in my community.
	Let me give three examples. Merton Rise is a family development north of Basingstoke. The plan was to have a GP's surgery at the heart of it, but that has been axed. Rooksdown, in the neighbouring constituency of North-East Hampshire, is also a family-based community. For four years, a portakabin has delivered important GP services to families who have produced not just one or two but as many as three babies while they have been living in that community. In the ward of South Ham, 25 per cent. of residents are over 65, and the largest number of 70-year-olds in the borough live there; however, its 1960s GP's surgery is bursting at the seams and long overdue for replacement.
	Although it is clear that Basingstoke greatly needs investment in primary care, no money has been forthcoming. However, the town has been identified as the favoured location in Hampshire for a town-centre polyclinic. Our PCT has told us that we must have one—we know that it has little choice in the matter—and it will be a significant distance from the communities that I have described. Moreover, the main rationale for the polyclinic is that Basingstoke is a commuter town. Polyclinics may have a role to play in urban and metropolitan areas, but they do not meet the urgent and pressing needs of families and elderly people in the outlying suburbs of Basingstoke. There is a need for basic GP provision, not a centrally dictated solution to a problem that is not the first priority for local residents. It seems perverse to spend money on increased access for commuters rather than mothers with young babies and the over-70s.
	Basingstoke's town centre already has plenty of GP provision, for historical reasons. We have a newly located GP's surgery, offering an extended range of services, right next door to our station. However, I understand that the present rules will not allow it to bid for a polyclinic, so there is a possibility of duplication where we really do not need it.
	The Government have put great emphasis on new funding, but it is not altogether clear that the message has reached the PCT in Hampshire. The matter was discussed in some detail at a PCT board meeting in March. According to the board papers, the chairman of the PCT patient and public involvement forum asked whether any services would have to be cut
	"to enable this requirement to progress"—
	that is, the requirement for a GP-led health centre. The PCT responded that the priorities would need to be "reassessed", which does not sound to me like a guarantee against cuts in health care services in the Hampshire area. Perhaps the Minister will clarify that when he winds up the debate.

Graham Stuart: If patients can register with an expensively laid-out new centre, they will take their money away from the GP's surgery—perhaps in the countryside, in an area such as the East Riding of Yorkshire—with which they are currently registered. That would undermine the funding of the surgery, and lead to the closure of GP services in areas such as Leven and Beeford in my constituency.

Maria Miller: That is an excellent point. My constituency also contains rural areas. I have already received letters from areas north of Basingstoke such as Bramley, where it is feared that the viability of providing GP services will be undermined. It is not, however, just a question of money. My main worry is that Hampshire PCT's attention will be diverted from resolving Basingstoke's genuine primary care needs. The PCT has just undergone an enormous reorganisation, and is now the largest in the country. It is clear that it has been struggling to deal with specific local problems, including the delivery of primary care in Basingstoke.
	During Health questions earlier today, the Secretary of State said that the Government had no intention of removing existing services, but by definition money will be diverted—whether it comes from the Secretary of State or the PCT—from solving the problems in existing services and ensuring that they can meet the needs of local residents. We must look after the elderly and families, those who need support the most, before turning our attention to other priorities that the Government may have—priorities that may be absolutely right for metropolitan and urban areas such as London, but do not hit the mark when it comes to our problems in Basingstoke.

Howard Stoate: There is something funny about this debate. I am the only practising GP left in the House of Commons, and apparently I am the only one with a good word to say about polyclinics. I honestly believe that they will give patients access to services that currently require some to travel many miles, and to which many others simply do not have adequate access.
	In my view, Ministers have given sufficient reassurance that most of the new services will be in addition to the existing ones. GPs will be able to work on a hub and spoke model, retaining their own practices if that is what suits the locality, or to locate their practices in polyclinics, maintaining the integrity of those practices while having access to all the extra services that are currently not so accessible.
	The idea of polyclinics is not new. A recent King's Fund paper on the subject refers to the Dawson report of 1920, which set out a vision of primary health centres that would focus on "curative and preventative medicine" and would provide an opportunity for GPs, nursing professionals, visiting consultants and specialists to work alongside one another. That model is exactly the same as the polyclinic model of today.
	The King's Fund paper suggests that one of the reasons the concept has not made much headway since then is the
	"singular lack of enthusiasm from the medical profession and in particular its BMA representatives".
	The National Health Service Act 1946 allowed health centres along the lines proposed by Dawson to be set up but did not make their adoption mandatory, despite Bevan's enthusiasm for the idea, owing largely to opposition from the professionals. Their opposition stemmed from
	"the BMA's hostility to any proposal which appeared to turn GPs into public servants".
	Unsurprisingly, therefore, by 1963 only 18 purpose-built health centres were in place.
	Vested professional interests were also partly to blame for the failure of the East German polyclinic model to survive reunification. In 2005, an article in the  British Medical Journal by German academics explained:
	"State owned policlinics were one component of primary health care in former East Germany, housing general and specialist doctors and dentists. This integrated model was efficient and cost saving: facilities and laboratories were shared, alternative treatment and prevention strategies were coordinated, and referrals to specialists were well monitored, as well as each patient's case. Policlinics did not conform to the West German concept of independently contracted doctors paid on the basis of an item of service, so they did not survive in East Germany after 1995."
	However, five years later, in 2000, the polyclinic model was back on the agenda in Germany, having been reinstigated by German policy makers in a bid to
	"increase cooperation between general doctors, specialists, and hospitals; to improve communication between institutions; and to reduce healthcare costs."
	That illustrates that we need to be extremely wary about the opposition to the current polyclinics proposals expressed by professional trade unions such as the BMA. The BMA says that it is not opposed to the polyclinics model per se, but that they need to be introduced gradually over time and not be imposed centrally, and that proper regard must be paid to the specific character of each local health economy. That is a perfectly sensible position to adopt, except that the BMA has been saying exactly that from 1920 onwards.
	As long as the polyclinic model remains an aspiration rather than a specific policy objective, the chances are that we will never see them in place across the country. As one speaker said last week at a meeting on polyclinics of the all-party group on pharmacy that I chaired, the irony is that the polyclinic model now being proposed has in fact existed for years in one branch of associated health care at least: veterinary care. In that field, large, one-stop, city centre clinics, comprising both generalists and specialists, and with impressive on-site diagnostic and treatment facilities, have been in place for years and have worked very well. It is a pity that the owners of the animals that are benefiting from that kind of one-stop, integrated care are still waiting for something similar to materialise in the NHS.
	Other health care systems around the world have, of course, been using the polyclinic model for years. The polyclinic proposal is far from being the untried, untested, experimental model of care that many in the media have claimed. As the NHS Confederation has stated:
	"The principles behind the idea of polyclinics are in line with the way in which healthcare is developing across the world. The design rules that underlie the idea of polyclinics appear to be fairly uncontroversial."
	The case in favour of polyclinics is, in fact, unarguable. They provide an unrivalled opportunity to create larger groupings of primary care professionals, and to create a critical mass that will allow an enhanced range of services to be provided. They exploit economies of scale to provide greatly extended diagnostic support with rapid access and turnaround, and a range of other services that are difficult to offer in smaller practices. They reduce the need for patients to travel to hospital by relocating high volume work that does not require hospital infrastructure. They will integrate services to break down the traditional barrier between primary and secondary care and provide opportunities for specialists to work alongside their colleagues in primary care. They will also create space for other services, including community health services and other related health, social care, leisure, housing and benefits services that patients, professionals and the community will value.
	There is, of course, a range of issues around how, where and why polyclinics are to be implemented, but none of the concerns that have been expressed is insuperable. The idea that they will inevitably undermine the direct relationship between a GP and their patient, for instance, is wide of the mark. The Berlin polyclinic, Polikum, uses a web-based scheduling system to ensure that patients who want to see their own primary care doctor can do so. They may only be able to see their GP during certain periods of the week, but that is no different from how the current system works. As now, patients have to weigh up whether a familiar face is more important to them than speed of access.
	Nor is it necessarily true that patients will have to travel further to see a GP. The hub and spoke model suggested in the Healthcare for London plans offers the potential to preserve local access while at the same time providing a community health care hub that offers a broad range of diagnostic and treatment services. In Liverpool, for example, the local PCT has set up a network of neighbourhood health centres and NHS treatment centres. Under that system, no patient is more than 15 minutes' walking time from GP services while there has been a corresponding shift of services out of hospitals and into the community closer to where people live.
	I suggest that the real issue is not whether the principle behind the polyclinics is the right one—I do not know of any serious commentator who fundamentally disagrees with them—but relates to their implementation, about which legitimate fears have been expressed. For example, the risk is that they could end up duplicating existing services provided in the community, and therefore waste money by creating overcapacity. If, however, their implementation is properly planned and managed and due regard is paid to current services, there is good evidence to suggest that they will help us make more efficient use of existing resources. Well-organised and integrated systems improve cost-effectiveness, reduce follow-up appointments and duplicated tests and improve the quality of care. The Kaiser Permanente model in the US shows us how this can be done, and provided that the polyclinic service contract is properly set and monitored, there is no reason to think that the advent of new providers will impact negatively on the quality of care offered to patients. After all, GPs are, and have always been, independent, for-profit contractors operating within the NHS. Those are the rules GPs elected to play by when the NHS was set up. With proper debate and consultation and due care taken in the commissioning process, there is every reason to think that polyclinics can lead to substantial benefits in terms of the quality of care offered to patients.

Richard Taylor: May I begin by declaring that I am a member of the British Medical Association and a fellow of the Royal College of Physicians? I am not speaking in order to give any official message from either of those organisations, however; I am speaking entirely on my own behalf, and on behalf of my constituents, local GPs and NHS professionals who have spoken to me.
	The debate has produced a huge benefit already, in that we should all now know what we mean by a polyclinic and a GP-led health centre. To me, a polyclinic is a body that brings together GP services, investigative services, probably hospital consultant clinics and probably a headquarters for community services, as well as dental services. That could be perfectly satisfactory in certain areas, particularly in big cities, although I note what the hon. Member for Birmingham, Selly Oak (Lynne Jones) said about her part of Birmingham.
	As for GP-led health centres, the Secretary of State has made it absolutely clear that they need only have three characteristics: they have to be accessible, to be open from 8 am to 8 pm 365 days a year, and to be able to accommodate drop-in patients and registered patients.
	I am grateful to the Minister for his reply to my parliamentary question of 21 May, which he kindly answered in the nick of time just yesterday. I asked
	"whether the decision to have a polyclinic in a primary care trust area is a decision to be made locally."
	If I may, I want to take his answer apart, and agree with certain bits and ask further questions.
	The first sentence of the answer is as follows:
	"How primary care trusts...choose to configure or commission local primary medical care services is a local matter."
	That is absolutely right; it certainly should be. I agree with that.
	The second sentence of the answer is:
	"However, all PCTs have been asked to commission additional general practitioner (GP)-led health centre services and have been given additional funding to secure those services."
	The key word there is "additional". I met the chair and chief executive of my own PCT yesterday, and in their paper about their plans for future health services in Worcestershire they state that the Department of Health requires every PCT to establish a
	"new GP-led Health Centre".
	To my mind, the difference between "new" and "additional" is vital, and I will return to it. I am a little confused about the reference to extra funding; is it really new additional funding, or is it part of the growth money already announced and passed to PCTs?
	The final sentence of the Minister's answer to my question is crucial:
	"PCTs will decide after local consultation where and how these services should be provided and will carry out an open and fair procurement to secure the services they specify."
	Deciding "where and how" is crucial. If extra hours and extra capacity are needed, some of the existing health centres around the country—this is certainly the case in my area—are closed from 6.30 pm and throughout every weekend, so spare capacity exists that could be used.
	In Worcestershire, the GP-led health centre is likely to be in Worcester, the largest town. If only the money for such services were given to the PCTs without strings attached, it might be feasible in Worcestershire to put in place three of these health centres—one in each major town. That would spread the benefit of 8 am to 8 pm opening and the benefit of such centres being open for the entire weekend across the county, but, as it stands, only those who are near enough in the city of Worcester will benefit. Such an arrangement would almost certainly do away with the need for new premises, because that existing spare capacity could be used. That would lessen the worry about continuity of care, and about the lack of local knowledge and of previous knowledge about patients, and it could even mean a rotation between different practices within a given area. Such an arrangement would be ideal. I am asking the Government to get away from insisting that these must be new services, because they could be additional services in areas where there is the capacity to provide it.
	Several right hon. and hon. Members have mentioned worries about the back door into commercialisation, and I share that fear. The last part of the answer to my written question stated:
	"PCTs...will carry out an open and fair procurement to secure the services they specify."—[ Official Report, 16 June 2008; Vol. 477, c. 768W.]
	If it really is open and fair, and if account is taken of the lack of need to build new premises if spare capacity in existing health centres is used, existing practices could probably compete on a fair basis with the huge commercial organisations that are gearing up to compete for the provision of such services.
	The fears of commercialisation have been rehearsed by Labour Members, and, in the interests of speed, I shall not go into them. I just want to remind the House about the need for local consultation and for accountability to local people. I went to a lunchtime launch of the Local Government Association health commission's final report on accountability, the executive summary of which said:
	"More recently, there has been a conscious effort to devolve decision-making, giving greater autonomy to NHS providers and setting a smaller number of national standards to sit alongside ones that are locally agreed."
	That is how we should decide on GP-led health centres, where they will be and what they will provide. I am convinced that GPs in their existing practices in the health centres could provide accessible 8 am to 8 pm, 365 days a year, drop-in and registrable services.
	There are alarms about commercialisation, and I wish to request a meeting with the Minister to rehearse with him some of the alarming allegations that I have received about how some of the commercial organisations function and to share with him two crucial letters in the medical press that sound warnings about commercialisation from the United States. I also wish to share the sensible points made by the organisation that is completely divorced from the BMA and is thoroughly rooted in the interests of patients: Keep our NHS public. I humbly request such a meeting.

Neil Turner: One of the most disappointing things about this debate and the motion is that they are focused entirely on the providers and not on where they should be focused—on the patients. That says an awful lot about the stance of the Conservative party.
	The hon. Member for Basingstoke (Mrs. Miller) said that nobody had spoken in favour of polyclinics, although my hon. Friend the Member for Dartford (Dr. Stoate) just did so. One of the reasons why that has been the case is that nobody has a health centre in their constituency. Interestingly, the hon. Member for North Norfolk (Norman Lamb) was calling for pilot schemes. I can tell him that we have quite a number of pilot schemes. In fact, he referred to some of them, in the sense that 12 areas have health centres, and Wigan is one of them. Indeed, Wigan was one of the first boroughs to have a local improvement finance trust—LIFT—centre. Parts of the borough have some of the worst health statistics in the north-west and, thus, in the whole country. It is also one of the most under-doctored areas in the country.
	The King's Fund, which was cited by the hon. Member for North Norfolk, has made a number of comments about health centres. I do not recognise those comments in respect of how we run the health centres and our LIFT programme in Wigan. For instance, it mentioned poor management, but each of our six health centres has a manager in charge to ensure that the organisation within, and between, the services provided is properly carried out. The King's Fund also mentioned a lack of innovation, but Wigan has a new and important innovation—our "Find and Treat" approach, whereby local GPs, through the health centres, go into the community seeking people who are particularly vulnerable to strokes and cardiac problems and try to bring them into the health centres for treatment. Rather than waiting for people to come once they have had their stroke or heart attack, when it is often too late, GPs are going out to ensure that we can treat them before that happens.

Graham Stuart: Most of the speeches that I have heard today did not attack polyclinics per se and did not say that they cannot contribute to local health needs. The main issue taken up by those opposing the Government plan is that polyclinics are to be imposed from the centre on every area, even when there would be better ways of spending the money. The hon. Member for Wyre Forest (Dr. Taylor) talked very well about how the money could be used creatively, using existing assets to deliver much more benefit for patients.

Neil Turner: I disagree with that analysis, because I do not think that is true. I think that health centres and polyclinics for the London area will provide better services and better outcomes for the patients. Our health centres in Wigan are doing that. They have the strong support of my three colleagues who also represent the borough—my right hon. Friends the Members for Makerfield (Mr. McCartney) and for Leigh (Andy Burnham), and my hon. Friend the Member for Worsley (Barbara Keeley). They all support the health clinics and the extension of the health clinic principle throughout the borough. Our six centres are all large, modern, adaptable buildings. The primary care trust arranges the sub-leases and each local health centre provides a massive range of services. Fundamental to that is a GP practice—or in several cases, a number of GP practices, all of which are local and none of which is provided by Virgin or any of the other organisations that have been mentioned. They are all local GPs who have voluntarily gone into those health centres to ensure that they can provide a better service from a better facility.
	Most of the centres also have a pharmacy, and the centres provide an enormous range of services. We are talking about child care, audiology, district nurses, community mental health, out-of-hours nurses, family planning advice, diabetic retinopathy—I am sure that my hon. Friend the Member for Dartford knows what that means—integrated therapy for children with special needs, minor surgery units, podiatry, physiotherapy, speech and language therapy, and older people's services. That list goes on and on, and many of those services are provided in most of the clinics.
	I want to give a couple of examples of what is done in one or two of the health centres, particularly the Platt Bridge health centre, which is in the Makerfield constituency. It covers a former mining community with immense health and social problems, and severe deprivation—it is in the 3 per cent. most deprived super output areas in the country. The health centre is marked out not because of the services it provides, although those are excellent—they include a hydrotherapy service—but because of the way in which my right hon. Friend the Member for Makerfield managed to get the primary care trust and the local authority to work together so that this is not just a health centre. It is in a huge complex that includes a school, library and community centre, all of which work together to provide a major centre for that deprived community, which has been given a belief in itself and confidence in its future. That would not have been provided unless the LIFT programme had provided the PCT with the catalyst for that centre.
	In Wigan, we have Boston House, named after Billy Boston, who was probably the greatest rugby league winger ever—as I am sure the hon. Member for Leeds, North-West (Greg Mulholland) will agree. It has a GP facility and a pharmacy, and provides nurse training provision, health education, podiatry and audiology. It has a 19-bed physiotherapy unit, but what sets Boston House apart from all the others—and is especially important for the people of Wigan—is the fact that it has an 18-bed renal dialysis unit. People from Wigan who needed dialysis used to have to travel to Salford or Bolton, which took a full day. That was disruptive and in some cases distressing for the patients and their families. Now, they can have dialysis in Wigan, and that is much less disruptive. I have talked to the patients involved and I know that it has massively improved their quality of life.

Greg Mulholland: If the hon. Gentleman wants to improve his health, it is not too late to register to play in the rugby league match a week on Saturday.
	The hon. Gentleman describes a facility that is clearly popular and works. Does he agree that that might work in Wigan, but is not necessarily the answer in Leeds, North-West or other areas? The imposition by the Government is the heart of the problem.

Neil Turner: One of the problems with this debate is that so many people say that it might not be the answer in their area, but not one of the hon. Members who has said that has had experience of it working in their constituencies. If hon. Members want to see how it works, I invite them to come to Wigan and talk to the people who provide the services in those health centres and, especially, to the patients, to see whether they like the centres. Instead of going along with the BMA's claims, hon. Members should come and see the reality on the ground. Then they might change their minds. The first three health centres in Wigan were not built in my constituency, and I knocked on the door of my PCT to ask when it would get one. Now it has.
	We have two other health centres in Wigan. The Sherwood Drive health centre has GPs and provides minor surgery services, a pharmacy and, after a recent extension, a dental practice. The Beech Hill health centre, which is my local one, is a GP centre with a pharmacy attached, and it provides numerous other services.
	Boston House health centre was provided by the LIFT programme, the Sherwood Drive health centre was provided by a private sector company, which has since sold it to the PCT, and the Beech Hill health centre was one of the very earliest health centres, built in the 1960s, and the GP practice has now moved into a modern centre. So there are many ways to provide those services. It is not a question of one size fits all.
	We will not rest on what we have done, excellent though that is. We welcome the extra funding for the health centres and we hope to have more such centres in the future. For example, one will complement the walk-in centre in Leigh, a second will be based in Ashton and a third in the Whelley/Scholes area in my constituency. The PCT has plans for three further primary care centres, plus one GP-led health centre in Wigan town centre, which will provide the services that the Secretary of State described earlier. In addition, it will provide services for homeless people, which are important.

John Pugh: The hon. Gentleman has said much about the new facilities. Can he tell us something about the effects they are having on his local hospitals?

Neil Turner: Because we have been so under-doctored, and GPs surgeries have been poor in the past, people have used accident and emergency at the hospital instead. Wigan A and E is a major trauma centre—it is next-door to the motorway—and has a high-dependency unit and an intensive care unit. Using doctors trained to provide those services for what is, in essence, primary care had a deleterious effect. The health centres, with their longer opening hours and wider range of services, have a beneficial effect. We need more such health centres, because we want to shift the NHS from being an organisation that treats ill health to one that intervenes to prevent people from getting ill.

Tony Wright: I wished to speak only because I have been genuinely shocked by aspects of the campaign that has been waged on this issue. Perhaps I am too easily shocked, but there has been a dishonesty in some of the campaigning that has caused much anxiety and even illness in some people. I had an elderly lady phone my office this week, and she said that when she had gone to her GP surgery she had been told that it would close. I checked with the PCT which told me that the surgery had plans to expand. It may seem clever to campaign in that way, but for people who claim to be concerned with the health of others, it is having a serious and damaging effect.
	It is worth remembering that we have been here before, when it comes to the NHS and the BMA. When the NHS Act 1946 received Royal Assent, the chairman of the BMA commented:
	"The Act is part of the nationalisation programme which is being steadily pursued by the Government."
	Section 21 of that Act stated:
	"It shall be the duty of every local health authority to provide, equip, and maintain to the satisfaction of the Ministry, premises which shall be called 'Health Centres'".
	The BMA said that health centres would be introduced over its dead body and, indeed, 10 years after the NHS was established, there were only 10 health centres in this country. That was because the GPs, represented by the BMA, would not have them. It has taken us a long time to realise that having a network of well equipped and professional health centres will have an immeasurably beneficial effect on the health of the population.
	When I was elected to Parliament in 1992, the report from the director of public health in Staffordshire said that my constituency, a former mining area, had the worst health, the greatest number of single-handed GPs and the highest incidence of secondary referrals from GPs to hospitals—usually an indicator of insecure medical practice—in the area. It was essential that that situation be transformed, and I can report that in many respects it has been. Because of investment, we now have a raft of state-of-the-art health centres across the district. Nobody would now claim that such developments are not beneficial to the health of the population. The idea that anybody could have resisted the development of health centres sounds so ludicrous now, and it will seem ludicrous in the future that anybody could resist the development of the next stage in health care, which is what we are talking about now.
	I am a great admirer of the primary care system of traditional family doctors, but unfortunately it has to be said that it has been very difficult over the years to make the necessary reforms of that system. To compress a short history, I was alarmed for many years that there was no proper system for the clinical audit of general practitioners. It took the horrors of Shipman to produce that system. We have to be realistic and say that it has taken muscle from the centre and often deeply disturbing events to get the general practice system to reform in the ways that it should.
	I was interested to hear the comments made by the hon. Member for Wyre Forest (Dr. Taylor). I greatly respect him and his experience. I do not want to misinterpret him, but I think that he was effectively saying that if the primary care system had developed in the way that it might have, with extended services, the need for these proposals would never have arisen. However, that is not what has happened. The system has resisted all proposals to extend. We need only think of the arguments that we have had just to get a modest increment in evening or Saturday morning provision, which was standard when I was growing up—it was quite normal to have evening surgeries or Saturday morning surgeries. We have now had to pay the doctors more to return to a system that we once had.
	It is bewildering that we cannot understand that it is possible to extend GP provision in a way that will genuinely extend choice and access for patients. We think about patient groups, and when my children were small we would have been heavy users of a super-surgery in our area. All we had, when children were inconvenient enough to get ill out of doctors' surgery times, was the prospect of a visit from an out-of-hours person who knew nothing about us and had no diagnostic back-up of any kind, or of taking the children down the local accident and emergency, which was probably inappropriate. The idea of having an intermediate centre for such situations, just so that tests could be done and people could be checked over, seems a genuine extension of patient choice.

Norman Lamb: I am sure that the hon. Gentleman would agree that we should be developing policy that is based on evidence. Does he not think that we should have serious concerns about the range of points made by the King's Fund and others? They show that the polyclinics and health centres already established under the LIFT scheme and the experience from abroad suggest that some of the conclusions that he wants to see are not happening.

Tony Wright: I am grateful for that intervention, as it gives me the opportunity to make my final point, which is about what happens if we cut through some of the nonsense and look at what is being proposed.
	As I mentioned in my intervention earlier, I had a very interesting document from the BMA, which was sent out to all GPs and local medical committees in May—just last month. The document is called "New NHS Primary Care procurements", and it is described as a "factual guide". It is an example of the BMA talking sensibly to its own people, rather than getting all excited about a public campaign against things that some people do not like.
	The factual guide includes a very nice table that sets out what it calls the "key differences" between health centres and polyclinics. Hon. Members can read it. It then goes on to describe the background to the policy, which is exactly the point that has been made. It talks about the Darzi review, and says that a central tenet of it
	"has been the importance of determining primary healthcare services locally."
	It goes on to state that the review sets
	"out a rigorous process requiring any change to be transparent, clinically evidenced, locally led and for the benefit of patients."
	When the BMA is talking for grown-ups, it tells the truth about what is on offer, but when it is putting petitions around surgeries and telling people that all their local surgeries will close, it talks dishonestly.
	The fact is that we have a proposal—it might not have been necessary if primary care services had reformed themselves in the way that they should have done over the years, but they have not—that will extend the range of services available to patients. That is a very good thing and it is dishonest to pretend otherwise.

Shona McIsaac: Like my hon. Friend the Member for Cannock Chase (Dr. Wright), I think that the BMA's "Save our Surgeries" campaign has been disingenuous. It has created unnecessary fear and worry that GP surgeries around the country are about to close. That is simply not the case.
	I want to talk briefly about the example from north Lincolnshire. My right hon. Friend the Member for Scunthorpe (Mr. Morley) intervened earlier on this point. Parts of Scunthorpe are very deprived, and they also have few GPs, so there is a plan for a GP-led health centre in Scunthorpe. Doctors have been saying that because of that plan other GP surgeries are under threat, particularly in the rural parts of north Lincolnshire. North Lincolnshire MPs went to the primary care trusts to ask what that was all about, and they guaranteed that the money for the centre was additional and that there was no threat to any other GP practice in north Lincolnshire. In fact, they wanted to invest more money in those other practices. People will still have access to their GP, and it is wrong to tell those people that their GP surgeries are about to close.

Graham Stuart: If the hon. Lady has been following the debate, she will have heard that patients can register with the new centres. If they move their registration from their former rural practice to the new centre, the rural practice will lose that patient and the income and could therefore become non-viable. It is not true to say that this is pure additionality, and the hon. Lady should perhaps have picked up on that by now.

Shona McIsaac: I think that I regret allowing the hon. Gentleman to intervene. He has been talking about people's GPs, the services that they provide and how much people appreciate those services—but people will stay with their GP if that GP provides a service that they want. If they want something else, they can transfer, as they can now. They can transfer from one GP practice to another if they want additional services.
	Earlier this year, I went out and consulted my constituents at random about what they wanted to see in primary care, what they wanted from their GP and what type of opening hours they wanted. I wanted to ask 150 people, but through a quirk I ended up with 151. When I asked whether they wanted GPs to open at more convenient times to meet their needs and their lifestyles, only one person opposed that, while 150 wanted access to GP services for more hours. As for evening appointments, 150 people wanted them and one person did not. There was not such strong support for weekend appointments, which were wanted by only 144 out of the 151.
	People wanted that increased access, which is what the GP-led health centres and polyclinics in London will provide, for a wide variety of reasons. One reason that struck me came from working women with young families. Although there is meant to be more equality in society, when it came to taking the kids to the doctor it was still the woman who had to do it. Generally speaking, she would have to take time off work, and the kids might also have to miss school. That was one reason why those women wanted early morning appointments or appointments later in the evening.
	In the Cleethorpes constituency, there are still a number of single-handed GP practices. That was another factor in people wanting more access. For example, if women had an older male GP, they felt uneasy about seeing him about issues to do with sexual health and said that they would prefer a larger health centre so that they could have that choice and have access to the type of clinic that they would not necessarily get in a single or double-handed GP practice. Plenty of people are perfectly happy with that set-up, and no one is suggesting that it will change. However, in my area patients have demonstrated a desire for more than just those single-handed GP practices.
	There are now health and medical centres in Cleethorpes and Immingham, just as there are in the area represented by my hon. Friend the Member for Wigan (Mr. Turner). The people who can access those health clinics really appreciate being able to use their services. Immingham is quite isolated from other urban areas in the constituency. The town's GPs came together and relocated to one building. Some people in the area had a bit of a pop, saying, "Oh my God, we've got fewer GP surgeries now." Technically that was true, but only because the GPs had all moved out of dilapidated premises and into a brand-new purpose-built primary care centre, where people can use a variety of services. My hon. Friend gave a list of the services, so I will not go through the complete list again. People can have their blood tests and X-rays done there, which means that they do not have to travel to the hospital in Grimsby, which is not easy to do from Immingham.
	The British Medical Association was therefore wrong to say that such health centres will always mean that people will have to travel further. That is rubbish; my constituents do not have to travel, because services are being provided on their doorstep. Recently, another GP-led health centre—the Beacon medical centre—opened in Cleethorpes constituency, and the people being treated there think that the wide range of services is excellent.
	The Opposition are completely out of touch with the public mood on this issue. We are no longer in the days of Dr. Finlay and his sidekick, moody grumpy Dr. Cameron —perhaps it is the name that makes the Conservatives so keen on their old-fashioned ideas. Those days are long gone. People's lifestyles are pressured. They have many demands on their time, and we have to make sure that primary care evolves and adjusts to meet their needs. If we do that, the NHS will be around for another 60 years after celebrating its 60th year next month.

Mark Simmonds: The motion is all about patients and the provision of health care for the maximum benefit of patient outcomes. This debate has been very revealing, in that the only speakers who supported the Government's policy came from that diminishing dying breed, the ultra-supporters of the Government.
	The debate was opened by the shadow Secretary of State for Health, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who gave a timely and devastating critique, mentioning the potential serious problem and the detrimental impact on patient care. He was right to highlight the problems of potential closures, the potential increase in travel distances, and the danger to the fundamental GP-patient relationship. In direct contradiction of what the hon. Member for Cleethorpes (Shona McIsaac) said, he mentioned the dynamic, strong feelings that patients and GPs have on the issue. He also highlighted the funding uncertainties: where will the money to support the policy come from? Even more importantly, he mentioned the fundamental lack of evidence to support the Government's policy, in relation to quality, access and service.
	We then heard the Secretary of State's response. He is usually highly polished and has a Teflon quality to him, but today he was clearly slightly over-excited, rattled and very confused. I suspect that he does not really want to have to defend the policy, because he knows that it does not make sense, particularly in the context of localised decision making—an idea that the Government trumpet—and clearly he was not enjoying himself. He tried to make a difference in definition between polyclinics and GP health centres, but it was clear from other contributions that they are the same. He quoted a London MORI poll in an attempt to support his policy, but the only recent poll that matters in London is the mayoral election, which was clearly won by Boris Johnson.
	The Secretary of State took an extraordinary, uncharacteristic and slightly sarcastic sideswipe at the hon. Member for Birmingham, Selly Oak (Lynne Jones), who made an extremely thoughtful and balanced contribution. Like us and, I suspect, the Liberal Democrats, she is trying to argue for more devolved decision making on how the money is spent. The Secretary of State's response to her contribution was extraordinary. Tellingly, he confirmed that primary care trusts would not be allowed to convert and expand existing practices, even if that was in patients' interests; there had to be a new polyclinic or GP-led health centre in every primary care trust, and even more in London. He made a bizarre attack on Conservative party policy, which is to try to find ways of improving primary care in socio-economically deprived areas, so that we can reduce health inequalities and improve things for those who do not have sufficient access.
	A significant contribution was made by the hon. Member for North Norfolk (Norman Lamb), who rightly confirmed the necessity of local decision making. He made a critical point about the importance of continuity of care, and about the danger that GPs' understanding of individual patients' medical histories could be eroded by the policy direction being taken. We next heard from the right hon. Member for Holborn and St. Pancras (Frank Dobson) who, let us not forget, is an ex-Secretary of State for Health. The current Secretary of State's view is that there is uniformity of opinion in London that polyclinics are a good idea, but that view was clearly shot to pieces by the right hon. Gentleman's contribution. The right hon. Gentleman was right to highlight the fact that the drivers of the polyclinics policy are Ministers in the Department of Health. The policy is not a response to patients' needs, to the NHS in London or to primary care trusts' desires elsewhere in the country.
	My hon. Friend the Member for Scarborough and Whitby (Mr. Goodwill) made a significant contribution. He was right to challenge the idea that the proposals would be the best use of resources in his constituency. In a lucid, considered contribution, my hon. Friend the Member for Basingstoke (Mrs. Miller) highlighted concerns in her constituency. At the time of his speech, the hon. Member for Dartford (Dr. Stoate) was the only Member to have supported the Government line. He is clearly very knowledgeable about the health service as a result of his professional qualification and his career, so it is sad that he always rises to defend Government policy, irrespective of what it is. He does not, perhaps, use his expertise and knowledge to make constructive suggestions for the Government. The hon. Member for Wyre Forest (Dr. Taylor) made a telling contribution, as always. He made one particularly good point: the policy should not be about buildings, but about patient services and pathways. That is one of the fundamental errors in the direction of Government policy.
	I will not allow Conservative Members to be painted into a corner and seen as the representatives of the British Medical Association. We are not its representatives; we are here to fight for patients and the improvement of patient services. We are not against polyclinics or GP-led health centres per se. In fact, when they are supported by patients, GPs and the local community, we will be supportive and will facilitate them and enable them to be introduced. However, the decision should be taken locally, and should be based on clinical evidence, and evidence on health inequalities and prevention measures. There should also be a comprehensive understanding of the impact on existing provision.
	The House needs to understand that we are not talking about a minor tweak to primary care. The establishment of polyclinics and GP-led health centres will be the largest change to primary care since the establishment of the NHS. In many places, including the Secretary of State's constituency, it has been said that the change would act as a catalyst for the reconfiguration of local GP services. It should be for local primary care trusts and patients, not Ministers in the Department of Health, to make the decision.
	Of course the Secretary of State is right that there are circumstances in which health centres of polyclinics would have a beneficial impact. He rightly gave the example of preventing multiple appointments and additional travel, particularly for the elderly and the vulnerable. We also recognise that there should be greater access to diagnostics and follow-up appointments, and it may be that such centres are the appropriate place to provide those services, but not everywhere, not uniformly, and particularly not in rural areas.
	Very specific criteria were set down by Darzi that the polyclinics and GP-led centres would be both cheaper and more accessible, but some hon. Members' contributions have demonstrated that that is not the case. The Government need to answer some specific questions. They do not seem to understand that there is a direct correlation between GPs and patient care and a threat to that relationship. Will the Minister also explain in winding up the debate whether a GP-led health centre means a GP presence all the time, from 8 am to 8 pm, seven days a week, 365 days a year? Why are there no pilots to produce evidence that the Department of Health can analyse?
	The Secretary of State confirmed for the first time that, on average, there will be five GPs per centre outside London. That amounts to an additional 605 GPs. Where will those additional GPs come from, in the context that there were only six more last year, if they do not come from surgeries that are already in place? Why will Ministers not allow PCTs to invest instead, where appropriate, in community hospitals or other GP-led health centres—a point made by my hon. Friends the Members for Beverley and Holderness (Mr. Stuart) and for Scarborough and Whitby? Why will Ministers not allow additional facilities to operate in non-spearhead PCTs—for example, outreach services?
	The policy is confusing. Lord Darzi said in his framework document that PCTs would not be allowed to reconfigure services until a PCT clinic review has taken place, giving evidence of the benefits. Where is the evidence—I hope that the Minister will explain this—to support the supposed benefits of a centrally prescriptive solution that is odds with locally determined reconfiguration? I suspect that the answer to those questions is that a one-size-fits-all proposal is not really about patient outcomes, but about political outcomes.
	There is an inherent contradiction between devolving commissioning responsibilities to a PCT through practice-based commissioning, and proposing a centralised approach to service design, with plans for polyclinics or GP-led health centres in every PCT. The Opposition will not coerce doctors into polyclinics against their will. GP-led health centres should be able to offer additional services, such as physiotherapy and phlebotomy, but they can be provided in other facilities as well in the existing system. This is not just about new buildings. Under the next Conservative Government, primary care will be patient-centric, responsive to local communities and free to innovate, ultimately to drive better patient outcomes.

Ben Bradshaw: Our primary care system of family doctors has served this country very well and is the envy of the world, and the Government are investing record sums in it. Funding for GP services has increased from £3 billion in 1997-98 to £7.86 billion in 2006-07. There are 19 per cent. more GPs today than in 1997. Incidentally, there were 273 more, rather than the six more mentioned by the Conservative party, in 2006-07 alone. They are better rewarded than ever before. More doctors are in training to become GPs, and vacancy levels for jobs are the lowest for many years.
	The new contract has also brought important benefits for patients: being able to see a GP within 48 hours or to book ahead, longer consultations and better outcomes. But in every recent survey of what the public would like improved in the health service, being able to see a GP at times that are more convenient for them comes top. That is part of the reason why in March we agreed with the BMA that surgeries offering opening in the evenings and weekends will be rewarded. I am pleased to tell the House that today 21 PCTs already have achieved the aim of at least 50 per cent. of GP surgeries opening in their areas either on a weekday evening or at weekends. We are confident that the rest of England will do so by the end of the year.
	Even with more than half of GPs offering extended hours, there may still be some people whose GP, for whatever reason, does not wish to open in the evening or at weekends, and we think it only fair that those people, too, should have the possibility of getting to see a GP at more convenient times. That is why we announced last autumn an extra £250 million to enable the local NHS to establish a new GP-led health centre in every PCT in England and extra GP surgeries in the least well-served areas. That is additional money on top of, not instead of, the record sums already going into existing GP surgeries. No one will lose their current family doctor as a result.
	In fact, one of the specific features of the new health centres is that people will be able to remain registered with their own doctors and see GPs in the new centres if they wish. The centres will be particularly welcome for people who work full time or commute, who currently find it hard to visit a GP, and they will also take pressure off accident and emergency departments, which deal with a lot of people who should see a GP. The only requirement we are placing on the centres is that they should be open seven days a week, 12 hours a day, and offer appointments and walk-in services.
	The hon. Member for North Norfolk (Norman Lamb) criticised the Government for moving too fast and predicted that we would live to regret our extra investment in primary care services. I suspect that when his constituents begin to enjoy the extended opening hours of GPs in Norfolk and the new 12/7 GP health centre in Norwich, or wherever Norfolk PCT decides to locate it, he will regret his opposition to those improved new services. He quoted the King's Fund report, which was much more balanced than the impression he gave—but of course, it was an analysis of a policy that is not being proposed.
	The hon. Member for Scarborough and Whitby (Mr. Goodwill), like a number of Conservative Members, said he was opposed to the new investment in his constituency. I am sure that other parts of North Yorkshire, such as York and Selby, might welcome it. His local PCT, as he well knows, will have assessed the needs of Scarborough and Whitby, and I understand that a public meeting in his constituency this week supported the proposals. He also said he was concerned about the provision of dental services. He might like to suggest that the PCT considers including extra dental services in the new centre. That is exactly what many PCTs up and down the country are doing. He asked whether the services need to be provided under one roof. No, they need not.
	The hon. Member for Basingstoke (Mrs. Miller) also said that she opposed the extra investment, in spite of the very significant population growth in her area. I suggest to her that, as in North Yorkshire, there are plenty of people in Hampshire who would welcome that extra investment. It is also not the case, as she suggested, that the existing GPs whom she mentioned cannot bid to run the new health centre.
	My hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones) is due to get not only a new health centre but a new GP surgery in her constituency because it is one of the under-doctored areas. Her constituents do not enjoy the same access as people in neighbouring constituencies in the Heart of Birmingham PCT, which has reached 75 per cent. access for extended hours on behalf of its patients. There is nothing whatsoever to stop the GP practice that she mentioned bidding for the new health centre. It need not be a new building; it can be an expanded existing building, and we have repeatedly made that clear.
	I make the same assurance to the hon. Member for Wyre Forest (Dr. Taylor). The new services can be part of an existing system, and there is nothing to stop Worcestershire adopting the kind of model that he favours. If he wants to make that case to Worcestershire PCT, he is very welcome to do so. The current proposal is for Worcester, but if he wants to persuade the PCT that his model is better, I wish him good luck. Of course, I would be very happy to meet him, as I always am.
	My hon. Friend the Member for Dartford (Dr. Stoate) made a very strong case in support of the improvements that we are making to primary care, as did my hon. Friend the Member for Wigan (Mr. Turner). He well knows that he will get not only a new health centre but three new GP practices in one of the most under-doctored areas of the country. He also made an important point about the huge public health benefit of investment in primary care.
	My hon. Friend the Member for Cannock Chase (Dr. Wright) gave an example of some of the disgraceful and irresponsible scaremongering by the BMA and the Conservatives that has caused unnecessary anxiety to patients, including his constituents. My hon. Friend the Member for Cleethorpes (Shona McIsaac) also welcomed the new investment and improvement in services.
	My right hon. Friend the Member for Holborn and St. Pancras (Frank Dobson) referred to a procurement that has nothing to do with the extra investment that we are announcing but is an ongoing process of PCTs procuring new GP services. His local PCT says that it is perfectly happy to defend the way the procurement was carried out. If it is not happy with the provider's performance, it can terminate or not renew the contract. I understand that the proposal for a new health centre in his area involves housing it in a local hospital because that is an accessible point locally, unlike in some other parts of the country where hospitals are not necessarily as accessible as other places.
	It is not only patients who welcome the new services. Anna Waite, a Conservative councillor in Southend, told her local paper two weeks ago that
	"this is a big step forward. A large surgery with easy access and in the right location will be ideal. To be open seven days is fantastic."
	Labour Members are delighted to have been given another opportunity to defend the Government's record on the NHS and highlight the further improvements under way in primary care. We do not think it unreasonable, given the record sums going to GP practices, that people should be able to see a GP in the evening and at weekends. We will not reverse those improvements or give a veto over health policy to the doctors' trade union, the BMA. I recall a similar campaign by the Conservatives this time last year against what they claimed was a programme of hospital closures. That campaign was humiliatingly abandoned when they were forced to admit that they had got their facts wrong. I predict a similarly bruising fall from this bandwagon.

Question put, That the original words stand part of the Question:—
	 The House divided: Ayes 202, Noes 298.

Question accordingly negatived.
	 Question, That the proposed words be there added , put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Mr. Deputy Speaker  forthwith declared the main Question, as amended, to be agreed to.
	 Resolved,
	That this House welcomes the Government's support for primary care and proposals to invest £250 million in 113 new GP practices in the most deprived communities and 152 new state-of-the-art GP-led health centres open from 8 a.m. to 8 p.m., seven days a week, in every part of the country; notes that these centres will offer a wide range of health services including pre-bookable GP appointments and walk-in services for registered and non-registered patients; recognises that the exact format and location of each GP-led centre will be decided locally in consultation with patients; notes that GPs will not be forced to work in the new GP-led centres and where that is the case patients will still be able to remain registered with their GPs at their existing location and premises; acknowledges that the expansion of primary care is essential if the overall health of the population is to improve, and inequalities in health are to be addressed; and welcomes plans to ensure enhanced primary care services are capable of meeting the new challenges facing the NHS including tackling lifestyle diseases such as obesity and through more effective screening programmes for the general population.

Sentencing Policy

Mr. Deputy Speaker: We now move on to the debate about sentencing policy and the early release of offenders. I must tell the House that Mr. Speaker has selected the amendment standing in the name of the Prime Minister.

Nick Herbert: I beg to move,
	That this House is concerned that a failure to plan adequate prison capacity has led to the End of Custody Licence scheme and the early release of 26,000 prisoners; notes that the current rate of prisoner release is running ahead of initial projections so that an additional 5,000 prisoners will be released early in a full year; expresses grave concern that no decision on whether to suspend this scheme will be taken until 2009, at the earliest, when prison capacity reaches 86,000 due to the Government's delayed prison building programme; agrees with the Lord Chief Justice that early release schemes erode the sentences originally handed down; further notes the low levels of public confidence in community sentences; recognises the objections of local communities that prisoners released early on home detention curfew are being housed in over 150 residential areas, without consultation, under the Bail Accommodation and Support Service scheme managed by ClearSprings; further notes criticism of the Youth Justice Board for failing to meet targets on youth crime; further expresses concern over plans to link resources to sentencing through the creation of a Sentencing Commission; and calls upon the Government to introduce honesty in sentencing, cancel the End of Custody Licence scheme, suspend the Bail Accommodation and Support Service policy and take immediate steps to ensure adequate prison capacity in the interests of public safety.
	This is the third debate that we have called in the House within a year on the early release of offenders. Since we debated the matter in July 2007, the situation has deteriorated. Last July, the prison population was more than 80,000; now, it is more than 83,000—an increase of almost 3,000, even after factoring in the early release scheme that started in June 2007. Last July, the Government had released 3,800 prisoners early; now, they have released 26,300 prisoners early. The prison estate is running at 99.8 per cent. of total capacity. In July, 86 prisons were overcrowded; now, 89 are. In July, 60,337 prisoners were in overcrowded jails; at the end of May this year, there were 63,176—another increase of 3,000. Almost one year has gone by, and that is what the Government have achieved.
	Sentencing policy and the continuing early release of offenders is a cause of real public concern, yet we return to the issue this evening because the Government simply are not listening. That is why the debate has had to be called. We have repeatedly asked Ministers to explain how they are going to provide the necessary prison capacity to hold all those sentenced by the courts, but instead of action we have been presented with a litany of poor excuses. Ministers say that they have provided 20,000 new prison places, and I am sure that we will hear it said again this evening. They do not say that almost 17,000 prisoners are now doubling up in cells—twice as many as when Labour came to power; that those extra places have been provided by doing such doubling up; and that almost one quarter of the entire prison population are housed in cells that are designed for one fewer person.
	Ministers say that they are embarking on a record prison-building programme, but the truth about their record is that after years of opposition from the former Chancellor, now the Prime Minister, they started the programme too late and it is already falling behind. Ministers say that they are tackling reoffending, but reconviction rates have increased. Even after the counting change, which Ministers are now so quick to fall back on, reoffending rates by ex-prisoners have risen since the Government came to power.

Jack Straw: indicated dissent.

Nick Herbert: The Secretary of State shakes his head, but in a letter on 27 November 2007, he confirmed to me that there was an increase in actual reoffending by ex-prisoners between 1997 and 2004. As the former chief inspector of prisons, Lord Ramsbotham, said this morning, reoffending rates are "embarrassing".
	After more than a year, what has the new Ministry of Justice, dedicated to protecting the public and reducing reoffending, actually delivered? It has managed to release a record number of prisoners early on to our streets. We have now had 10 months to evaluate the end of custody licence scheme: a policy that has greatly damaged public confidence in the criminal justice system, that was described by the previous Lord Chancellor as "simply wrong"—a month before he introduced the scheme—and that was dubbed a "very temporary measure" by the former Prime Minister.
	On Friday next week, on the anniversary of the end of custody licence, we expect that more than 28,000 prisoners will have been released early on to the streets in 11 months. The rate of release is running well ahead of initial projections. When the latest figures were published, I wrote to the Secretary of State to ask for an explanation. He replied by saying that the original estimate was quickly updated after the scheme started—in other words, the Government got it wrong in the beginning. He now admits that revised projections after the first week of the scheme led to a projected one-year total of 28,600 prisoners to be released early. But that revised—and, I assume, current—projection is still a gross underestimate. We have looked at the rate of releases, and we expect the total to be more like 31,000 in a year—5,000 more than Ministers cited when the scheme was launched.
	When will this so-called temporary scheme end? The Justice Secretary will not say, or pretends not to know. In an interview with the Press Association earlier this month, he said:
	"If you ask me when it's going to come to an end, that depends on the availability of prison places and I'm afraid to say 'not yet' is the answer."
	He has refused to say when the scheme might be suspended, but others in the Government have been rather more forthcoming. On 7 May, the Prime Minister said in the House:
	"When we have built up the number of prison places from the 60,000 that we inherited—now 80,000—to 82,000 and then 86,000, we will make our decisions on the right thing to do about early release."—[ Official Report, 7 May 2008; Vol. 475, c. 696.]
	So now we know; end of custody licence will not be suspended until many thousands more prison places are brought on-stream. The Justice Secretary confirmed that in response to my letter and parliamentary question, perhaps unwittingly helping to clear up the ambiguity. He now estimates that prison capacity will reach 86,000 by "around September 2009". In other words, we should expect at least another 15 months of this policy, and along with it another 35,000 prisoners being let out early on to our streets. Will the Secretary of State confirm today that what the Prime Minister said was right, and that no decision will be taken on ending this disgraceful scheme until September next year?
	We should reflect on the price of this policy, which is much more than mere numbers. More than 500 violent offenders were released early in March, taking the total number of violent prisoners released to almost 5,000. A total of 820 offenders have been recalled to prison while on end of custody licence, 144 of whom remain unlawfully at large. At least 451 crimes have been committed by prisoners who should have been behind bars. Almost every day, the media report another victim of a criminal who has, in one way or another, been released from prison early. The Secretary of State plays down the importance of this. He recently said:
	"I understand public concern about it but it is only two and half weeks off a sentence."
	Only two and a half weeks? Frankly, I find that response complacent. It is no consolation to the hundreds of unnecessary victims of crime. Two and half weeks was time enough in the case of Amanda Murphy, a teacher who was beaten to death by her violent partner just days after he was released early from prison. Only last week, we learned of the case of Derek Burns, a violent offender with a string of previous convictions, who stabbed his partner in the back with a 10-in meat cleaver when he should have been in prison. He told the paramedics:
	"I cannot believe they let me out. I told them I would do it."
	But let out he was, because early release under the Government's end of custody licence scheme is automatic—prisoners do not even have to apply. No individual risk assessments and proper accommodation checks are carried out.

David Davies: My hon. Friend is making some powerful and important points. Will he confirm that if he becomes Minister for Justice, as I hope he will shortly, he will end all forms of automatic early release and prisoners will be released only if they have earned the right to get out of jail?

Nick Herbert: I am happy to confirm to my hon. Friend that we will scrap the policy of end of custody licence and scrap the policy of automatic early release of offenders, to which I will refer shortly.
	As I have already said, under the end of custody licence, no individual risk assessments and no proper accommodation checks are conducted. As the National Association of Probation Officers has warned, violent criminals are released early— often back to the homes of the partners they were in prison for beating up—getting out of jail before their victims expected it and with no warning. With this appalling policy comes a human price. The moral case alone demands its cancellation, but prison capacity apparently does not allow it.

Humfrey Malins: I hope that my hon. Friend agrees that we should be having a very different sort of debate. In the Criminal Justice Act 2003, we had the much-vaunted custody plus—an entirely new form of sentencing for our courts that was trumpeted by the Government as a huge bonus to the criminal justice system, yet five years later they have not even introduced it into our courts.

Nick Herbert: My hon. Friend, who speaks with great expert knowledge on these matters and sits as a recorder, is absolutely right. Perhaps the Justice Secretary could explain why, after five years, custody plus has not been introduced.
	It is a measure of how serious prison overcrowding has become under this Government that a policy that in a full year saves only 1,200 prison places cannot be suspended because apparently there are not that number of places available, or likely to be available, in the near future.
	There is a second question that I should like to put to the Secretary of State. The Government told us that 2,500 new prison places would be delivered in 2007.

Richard Younger-Ross: There is obviously a problem with prison overcrowding. Does the hon. Gentleman agree that we could reduce prison numbers if those with serious mental health issues were identified and placed in forensic mental health institutes? Will his party commit to expanding that service so that it could take them instead of their being put in prison?

Nick Herbert: I agree about the problem of prisoners with serious mental illness, but there are two points to make. First, if, instead, they are put into places where they are treated, those are likely merely to be secure places of a different kind. Many of us—including, I suspect, the Secretary of State—would agree that that is a desirable thing to do. Secondly, the Bradley review is investigating how such people could be diverted to places where they can be treated properly. Although the hon. Gentleman might be able to say that that reduces the prison population, and it may be highly desirable that those offenders are not treated in prisons where it is not appropriate for them to be detained, it will not necessarily reduce the overall numbers of people in some form of custody.

Richard Younger-Ross: Is the hon. Gentleman aware that the recidivism rate for those who are treated in mental health institutions is only 10 per cent., compared with the figure for those who have been in prison? In time, therefore, the prison population would be reduced because recidivism would be reduced.

Nick Herbert: The hon. Gentleman makes a fair point. Indeed, a reduction in reoffending is an important way of reducing pressure on prison population growth in the long term, and the point that he makes may represent one means of achieving that. I doubt that there will be disagreement between hon. Members of any party about the desirability of removing offenders with serious mental illness from our prisons. The issue is one of resources and potential expense. It is true that there has been a big displacement of prisoners from former mental health institutions into the criminal justice system; it is not just the prison system that has picked up on that, but the police. We all recognise that problem.

David Howarth: Would the hon. Gentleman tell the House what his first priority would be? Would it be to obtain more secure mental health facilities, or would it be simply to build more conventional prisons?

Nick Herbert: I will come on to explain to the hon. Gentleman, if he has not read our policy document, that we propose an increase in capacity above what the Government propose to deal with overcrowding. On the question of how to deal with mentally ill prisoners, we shall await the outcome of the Bradley review, and if the hon. Gentleman is sensible, he will do the same. I must make progress, but I hope that I have answered the many questions put to me by the Liberal Democrats.
	I have a second question for the Justice Secretary. The Government told us that 2,500 new prison places would be delivered last year, but they comprehensively missed that prison-building target. They managed to increase capacity by just 1,367 places—just over half their target—and there is no sign that things will be better this year. Since January, there are nearly 3,500 more prisoners in our jails, but far less than half that number of new places. Let us remember that most of those new places are just last year's new places delivered late. Strip those out, and prison capacity this year has increased by fewer than 300 places.
	With prison capacity and early release, the familiar pattern of this Government's policy continues: release criminals more quickly and build prison places more slowly. The Government will not admit that even if they deliver the promised extra places by 2014, total prison capacity will still be many thousands of places short of their own median projection for the prison population by that time. They published a consultation paper on titan prisons, and they say that they intend to press ahead with plans to build three massive prisons—in the north-west, London and the south-east. Those prisons will take up 50 acres, which is a footprint larger than two Wembley stadiums. They will be the biggest prisons in Europe, in the face of all of the evidence that smaller prisons are more secure and superior for the purposes of rehabilitation. After all the urging by prison reform experts about the importance of local family links to the reduction of reoffending, why are the Government pursuing the policy of titan jails?

Mark Pritchard: Given the Government's record of not consulting local communities, even over bail hostels, does my hon. Friend expect them to consult local communities on titan prisons? Does he agree that there should be a full local planning consultation process involving local councils? Titan prisons should not be driven through by the new planning infrastructure commission.

Nick Herbert: I agree with my hon. Friend. I believe that the Government have pursued the policy of titan prisons—a name that they chose—because they wish to subvert local planning procedures and thereby increase capacity without having to obtain the consent of local people. That is wrong, just as the policy of siting very large prisons away from the prisoners' local communities is wrong.
	The Government's paper trumpets the potential efficiencies of titan jails, but admits that the Ministry of Justice has not done enough research to present a cost-benefit analysis. If these monstrous warehouses ever get built, projections show that they will be overcrowded by almost a third from day one. Old habits certainly die hard. In the short term, prison capacity pressures were going to be addressed by the acquisition of a prison ship. Whatever happened to that? What happened to that ghost ship? Perhaps the Secretary of State could update us.  The Sun is certainly keen for an update.
	Years of failure and today's belated and inadequate prison-building programme have come at a price. In an interview with  The Daily Telegraph in May, the former Lord Chief Justice, Lord Woolf, clearly warned of the dangers when he said:
	"The present situation is extremely worrying. I don't think prisons will blow up tomorrow or next week but there is certainly a danger of that. The prison service is very good at handling prisoners, but they are at bursting point. We are getting into the danger area."
	Can the Secretary of State tell the House what the current state of the prison-building programme is, how many new places will be opened this year, and why the prison-building programme this year and last year fell so far behind plans?

Alan Beith: The hon. Gentleman just quoted the previous Lord Chief Justice and his motion ill-advisedly quotes the present Lord Chief Justice. I say ill-advisedly because it is not good to draw judges into debate in that way. Does he recognise that both of those learned judges have considered a wider range of issues at length, including the effect of heavy spending to meet growing prison numbers on the very expenditure that could be used to keep people out of prison?

Nick Herbert: The plans that we have set out effectively propose diverting resources spent on reconvicting prisoners in order to try to prevent them from reoffending, which would be the transfer of resources that the right hon. Gentleman seeks. All of us want to see a reduction in the long-term growth of the prison population, but the question is how that is to be achieved. The Government's approach is wrong, as I am about to set out, and those who believe that there is an easy way of preventing the sentencing of prisoners in the first place by diverting prisoners into community sentences in which the public have no confidence are misguided.
	Faced with the reality of their failure, the Government are trying a new tack. Since they do not have the prison places, they want to fetter the ability of judges to hand down custodial sentences. They call it, in the words of their amendment to our motion, "a structured sentencing framework". The new device is a sentencing commission. They pretend, in the words of the amendment, that it is about delivering "greater consistency in sentencing", but there is already a statutory duty on the Sentencing Guidelines Council and the Sentencing Advisory Panel to promote consistency in sentencing. It is by no means clear whether the Government have any idea of how compliant judges are with the guidance of the Sentencing Guidelines Council at the moment.
	The Government have never said that demographic or geographic sentencing disparity is a problem that a sentencing commission is designed to iron out. The idea that a sentencing commission would simply promote consistency is a canard. The Government's proposals are nothing other than a back-door attempt to manage down the prison population by fettering judicial discretion. As we have said before, linking sentencing to resources in that way is wrong in principle because it would provide a formal mechanism for the Executive to exert control over sentencing and the judiciary.
	Lord Carter himself admits that there are many drivers of the prison population, not least the amount of violent crime, reoffending rates and the volume of foreign prisoners detained after their release date, awaiting deportation. The Government's record on those external drivers of crime and the prison population is frankly appalling, as we all know. In the light of that, any artificial method of linking sentences to resources would be dangerous and wrong. Violent crime has doubled under Labour. If that trend were to continue under a system that links resources to sentencing, we may find sentences for violent offenders would be shortened because of a lack of capacity.

Jack Straw: rose—

Nick Herbert: As the Secretary of State is about to intervene, I ask him whether that shortening of sentences is what he intends.

Jack Straw: No, and I shall deal with that point later. The hon. Gentleman's claim that violent crime has doubled is untrue. He must know that two separate changes occurred in recording crime—one in 1998 and the other in 2001. Both increased the recording of all crimes. In 1998, the change increased the recording of violent crimes by 80 per cent. overnight. The problem that we faced, to which we have now adjusted, was that, under the system that the Conservative Administration used, an awful lot of crime was not properly recorded.

Nick Herbert: The Government always fall back on the defence of counting changes. As the Secretary of State knows, even with those changes, violent crime has increased under the Government. Does he at least concede that? A huge amount of crime continues to go unreported. If he is in denial about the amount of violent crime in our country or public concern about it, he is in an even more serious predicament than the Government.

Jack Straw: I am in no sense in denial about the matter. When increases in crime occur, I am ready to admit to them. It is important in such a debate to deal with reliable statistics. One violent crime is too many, but does the hon. Gentleman acknowledge that, according to the British crime survey, which the previous Administration rightly established in 1981, violent crime has decreased by 31 per cent. since 1997?

Nick Herbert: The right hon. Gentleman knows that the British crime survey misses out swathes of criminal activity, including crimes against young people. The Government rely on it when it suits them. Indeed, some crimes have been increasing according to the British crime survey recently.

Jack Straw: rose—

Nick Herbert: Hold on. Instead of trading statistics across the Dispatch Box, let me make a proposal to the Secretary of State. The publication of crime figures should be on a basis that is wholly independent of the Government. They should be published by a body that reports to the House, not to the Government. Will the right hon. Gentleman concede that the Statistics Commission criticised the Home Office for its presentation and spinning of crime statistics, and that we cannot accept the defence of recounting from a Government who have been so quick to manipulate figures when it suited them?

Jack Straw: I certainly do not concede that. The Government have progressively ensured that the Office for National Statistics is entirely independent—I personally supervised that policy over 11 years. I went to the launch of the Statistics Commission, which is independent of Government. I agree that there will be no public confidence in official statistics unless such bodies are independent. However, if, according to the hon. Gentleman, crime has increased, why did the Leader of the Opposition accept that
	"crime has fallen dramatically under Labour"?
	Who is right?

Nick Herbert: I doubt whether the Leader of the Opposition said that. Of course, some crimes—for example, acquisitive crimes—have decreased, but the right hon. Gentleman should know about public concern, especially about violent crime. The publication of crime figures is not properly independent of Government. It is our policy that they should be independent so that they are not capable of manipulation and we have a proper index of the amount of crime in which the public and all hon. Members can trust. Unfortunately, the Government's consistent manipulation of crime figures means that that trust in the figures does not currently exist.
	Let me revert to the issue of the proposed sentencing commission, because it is an immensely important matter that raises issues of principle about the relationship between the House, the Executive and the judiciary, which should be independent. I repeat the point that I made to the Secretary of State. If a sentencing commission is introduced, we may find ourselves in a position whereby sentences for violent offenders, irrespective of any decision by the House, could be shortened due to a lack of prison capacity. Indeed, I assume that that is the right hon. Gentleman's real objective. Ministers would avoid their responsibility to ensure public safety, and effectively outsource sentencing decisions to a quango. Linking sentences to resources will entail a massive reduction of judicial discretion.

Jack Straw: I am grateful to the hon. Gentleman for giving way again. Let me reassure him that what he has outlined is in no sense the purpose of the proposal. I shall explain it in more detail in my speech, and I hope that he and other Conservative Members will then be reassured about it.

Nick Herbert: We will wait and see. It is difficult to know why the Secretary of State is so keen to pursue the idea of a sentencing commission, if not with the express purpose of finding a means of managing the prison population down. However, I look forward to hearing what he has to say about it.
	Linking sentencing to resources could entail restrictions on judicial discretion. To manage down prison populations successfully in the United States—an international example, which I know the Secretary of State and Lord Carter have studied—individual state sentencing commissions allow almost no room for judges to depart from the prescribed sentence range in any given case. The ability to treat cases differently must be severely curtailed for any such system to have a chance of working.
	Perhaps the Lord Chancellor should remind himself that his statutory duty is to protect the independence of the judiciary. Even if the regime is restrictive, there is no guarantee that the prison population can be effectively managed down. As Nicola Padfield of the law faculty at Cambridge university said in her evidence to the Justice Committee,
	"if we create something more rigid than we have at the moment, it is likely, on the evidence that we have, to talk up sentencing levels rather than talk down the sentencing levels."
	The judiciary is deeply concerned about the proposal, as the Secretary of State must know. The most senior criminal judge in the country, Sir Igor Judge, remarked that
	"the point about the judicial discretion is that a judge is trying to do justice in the individual case and that is what he must be allowed to do. If I may say so, it does not matter what guidance is offered, what framework comes up, if that is interfered with, then we are going down a very strange route."
	The restrictions that sentencing commissions place on judges encourage them to game the system, which leads to manipulation and perverse outcomes. There is strong evidence that, in Minnesota, judges sentence offenders to local jails rather than state prison to keep the headline prison population low. That shows that prescriptive regimes may not even work as intended. Sentencing commissions manage growth in prison populations through artificial, arbitrary and dangerous methods.
	Sentencing commissions do not reduce overcrowding and manage prison populations through some magic formula. They identify pressures on the prison population, caused by the external drivers, which Lord Carter cited, and then shorten prison sentences and reduce the impact of previous convictions on certain classes of offenders. That is how they work.
	It would be no surprise if such an approach reduced pressures on the system, but that is no way to keep the public safe. It is no way to build public confidence, either. The Bar Council recently said that
	"we believe that it is more likely to undermine public confidence in the criminal justice system".
	I ask the Justice Secretary today to reconsider the misguided policy and to confirm that the working group that Lord Gage leads does not represent a commitment by the Government to introduce such a mechanism, come what may.
	The Government have found another way to reduce the prison population by stealth. More than 500 early release prisoners on home detention curfew and criminal suspects are being housed by a company called ClearSprings in more than 150 properties in residential areas. In a letter to colleagues in April, the Minister of State, Ministry of Justice, the right hon. Member for Delyn (Mr. Hanson) stated:
	"In acquiring the properties ClearSprings has a contractual obligation to consult with police forces, probation and Local Authorities so that local knowledge can inform the selection of addresses. This enables us to avoid inappropriate locations."
	He omits mentioning that consultation is limited to those parties. It does not include the residents of streets where those de facto open jails are dumped on to local communities without warning.
	Ministers have referred to residents being notified. Is the Justice Secretary aware of what notification by ClearSprings entails? For his benefit, I have a copy of the leaflet that ClearSprings put through the door of a local resident in my constituency, which was the only notification that ClearSprings gave the public when it attempted to open such a property in Arundel. It reads:
	"Dear Occupants,
	I am writing to you to inform you that the property next door...is now being managed by ClearSprings Management...as part of our supported housing programme."
	The leaflet then supplied a contact number. In what way does that explain the role that the property will play? There was no explanation about early release prisoners or suspects being accommodated and no reassurance about the policing and security arrangements, just a flier and a national rate telephone number.
	The Minister of State, the right hon. Member for Delyn, has said:
	"The service is proving a success".
	On what grounds is the service proving a success? Here is the give-away:
	"The service is reducing the pressure on prison places".
	That is what the scheme is about. The Government have simply encouraged the courts to make more use of bail, as the prison overcrowding crisis has worsened. The bail accommodation and support service run by ClearSprings is the result.

Dari Taylor: The hon. Gentleman is making an appropriate statement to the House, and I totally agree with some of what he has said. Consultation with the local community has been rather thin on the ground, and it would have been infinitely better had it been more defined. However, he can take it from me that the relationship between that organisation and the police in my constituency has become very effective. There has been no objection in the community, because frankly there has been no reason to object. Does he accept that what we are attempting to do—reintroducing offenders into the community, which his party has said is an appropriate way of doing things—can have some beneficial outcomes?

Nick Herbert: The hon. Lady cannot have spoken to the many people, from all over the country, including from constituencies represented by hon. Members in all parts of the House, who have contacted my office to express concern about the policy. We are talking about effectively open jails, which open next to people in residential areas without their knowledge. ClearSprings does not provide active supervision of the prisoners concerned.
	In many cases, the properties have been opened in wholly residential areas, where the prisoners or suspects have no access to any of the necessary support services. People who live next door to such properties have expressed concern about disruption, noise, the constant police presence and the potential effect on property values. The policy is, frankly, disgraceful, and it is made more disgraceful by the fact that an attempt has been made to conceal it from the local community.
	The scheme has caused immense distress to local communities up and down the country. I might add that it was not debated in the House before it was introduced. It is a discredited policy and it must be suspended, pending a thorough review and a debate in which hon. Members in all parts of the House can relay the problems that they have been experiencing with the operation of bail hostels by ClearSprings.
	Prisoners released on end of custody licence and those let out on home detention curfew are not the only ones to benefit from early release. Under the Government who pioneered stealth taxes, we now see the stealth release of prisoners. Numerous measures in the recent Criminal Justice and Immigration Act 2008 were explicitly designed to reduce pressures on the prison population. We had the failed attempt to abolish magistrates' powers to impose a suspended sentence, as well as measures to reward tagged prisoners with days off their jail term to take account of time that they had spent in bed at home while on bail. We also had measures to align release arrangements with a technical change, smuggled late into the Act, that allowed automatic release at the halfway mark to apply retrospectively for offences committed before 2005.
	Now we have learnt of another stealth release scheme, in new guidance from the Prison Service on time unlawfully spent at large. The latest Prison Service instruction says:
	"In exceptional circumstances, it may be appropriate to allow a period spent"
	unlawfully at large
	"to count towards completion of the sentence."
	What circumstances? The instruction sets them out:
	"For example, if the prisoner will lose irreplaceable employment and accommodation links"
	or
	"Where the prisoner is a primary carer".
	In addition,
	"short periods of UAL—up to a month—may be allowed to count at the discretion of the Area Manager".
	That time is time unlawfully spent at large. It gets worse—the document says that the time counted may be
	"Where a prisoner has escaped".
	Prisoners who escape may be allowed to count the time spent on the run as having been spent in prison. This is what the latest Prison Service instruction says:
	"Where a prisoner has escaped, both the day of the escape and the day of recapture will count as part of the custodial period of the sentence".
	That means two days off automatically for any prisoner who escapes. Only this Government could give time off for bad behaviour.
	Those policies of stealth release may save a few prison places, but they are no solution to the problems that we face. Stealth release does lasting damage to public confidence in the criminal justice process and sends the wrong message to criminals. If ever there was a time for new thinking, it is now.
	We have set out plans to restore confidence in the criminal justice system, redesign prisons for the 21st century and launch a rehabilitation revolution. We would create prison and rehabilitation trusts with clear accountability. We would pay them by results, rewarding their success in reducing reoffending. We would trust professionals, giving governors new powers and freedoms to unlock the private and third sector to run rehabilitation services in and out of prison and give offenders the support that they need to go straight.
	At the beginning of April, the Lord Chief Justice criticised early release schemes and the lack of transparency in sentencing:
	"Where prisoners are released in these circumstances, that is to a degree—not a big degree—an erosion of the sentence that the judge imposed and anticipated would be served. I think it would be very much better if one had a clear sentencing structure, where if you imposed a sentence you could see how long that individual might spend in prison and when they would be eligible for parole."
	We agree. That is why we want to see honesty in sentencing. A Conservative Government would legislate for minimum and maximum sentences, to create that honesty in sentencing. When handing down a sentence, the court would have to explain the minimum and maximum sentence, and also the rules according to which it would be implemented.
	Under our policy of earned release, no prisoner would be released before the minimum had been served. Release after that point would be conditional on the conduct of the offender in custody. That means that both the victim and the public will know when the prisoner will be considered for release on licence, and also that the offender may serve longer than the minimum if he does not earn his release by fulfilling his conferred duties in the system.
	For that reform, and to address the urgent need to reduce overcrowding, we recognise the need for additional capacity. That is why we outlined our proposal in March for 5,000 more prison places above the Government's plans—not to increase the prison population, but to deal with overcrowding—that would be funded by a redevelopment of the prison estate. Our reforms have at their heart the recognition that public confidence in our criminal justice system has been gravely undermined by the early release of prisoners and a failing penal system. That confidence must be restored.
	But more than that, we recognise that in the long term, the right way to prevent the unsustainable growth of our prison population is to reduce reoffending. We all know that reoffending rates have remained stubbornly high. A leaked internal memo from the Government admitted as much. It said that recidivism rates for young criminals remain some of the highest in the developed world and that they "have not significantly changed" since 1997. Ministers will claim progress, but like so much from this Government, it is all about how we measure it.
	The truth is that our prisons do not do enough to rehabilitate offenders. Indeed, in their current state of overcrowding, they are doing less now than they did 10 years ago. We cannot go on administering giant human warehouses, where nothing much happens except drug taking and bench pressing. We have to create regimes where offenders work hard, learn skills and get support to break their drug addiction, so that they leave less likely to reoffend. We need to create prisons with a purpose; reducing reoffending will help break the cycle of crime. We recognise that we will not make Britain safer unless we reduce reoffending; and we will not reduce reoffending without ending overcrowding and without constructing purposeful regimes. That is the only acceptable way forward to deal with the current problem.
	The truth is that the Government are paralysed. There is total incoherence across Government policy. Ministers are constantly buffeted by events. We were the ones who led calls for stronger sanctions and robust enforcement for knife crime; then the Government followed us with calls for a presumption in favour of prosecution. We led calls to tighten the bail laws; and only now, four months on, do the Government bring forward their own narrow and rather unimpressive consultation document.
	We have set out our ideas for reform, so where are the Government's? If Ministers are simply to attack every positive proposal for change, if they are going to resist every new idea and if they are just going to maintain their tired refusal to act, the future really is bleak: prisons in a permanent state of overcrowding; ever more desperate emergency measures to bring the situation under control; turf wars between Government Departments and conflict with the judges whose independence is threatened; the biggest jails in Europe warehousing offenders; prisoners transported hundreds of miles around the country in a search for available places; drugs freely available in jails, which should be places of security; short-term prisoners being released with little or no support in the near certainty that they will reoffend. Politicians should not use the word "crisis" lightly, but the prison system is in a state of crisis. If Ministers do not think so, they do not deserve to be able to continue to run the system.
	Last month, my right hon. Friend the Member for Witney (Mr. Cameron) received a letter from a 17-year-old prisoner in a young offender institution. I think that the House should hear what he had to say. He said that he had been in the young offender institution
	"for the past seven months. I am currently serving 30 months; I have been in before and served an 18-month sentence; I am only 17 years old. I would like to get help to stop me reoffending in the future, but I would like to tell you that I received no help and do the same things, day in, day out. I attend gym in the morning for an hour and education in the afternoon for two hours and then one hour's association in the evening. I am locked up 19 hours a day during the week and 22 hours a day of a weekend. I want to learn new things, but there is nothing for me which I haven't already done. I want to learn new skills which will help me get a job when I leave prison, but I would like to say that the Government need to look at the way the prison system for young prisoners is run and do more to help people like myself. I might as well not be in prison; I might as well be at home and locked in".
	What hope are the Government offering young offenders such as him? What hope for communities blighted by their crimes?
	Let us hear no more excuses from the Government. Let us hear no more pointless attacks on what a previous Government did more than 11 years ago. Let us hear from the Justice Secretary what he is actually going to do about our penal system. In the words of the Lord Chief Justice:
	"We simply cannot go on like this".

Jack Straw: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"welcomes the Government's record in cutting crime by a third, its provision of 23,000 more prison places since 1997, and its commitment to create a total of 96,000 prison places by 2014, demonstrating that public protection is at the heart of its strategy; further welcomes the Government's commitment to remove the End of Custody Licence Scheme when headroom allows; notes that the use of police cells is much lower than under the previous administration; further welcomes the tough and effective community sentences that have been introduced and the work done to increase public awareness of their role and effectiveness, and the further investment in intensive alternatives to custody to continue to build the confidence of sentencers in their effectiveness, as demonstrated by significantly reduced re-offending rates; notes in respect of the Bail Accommodation and Support Service that ClearSprings is required to consult the police, local authorities and probation to avoid inappropriate property locations; considers that there should be greater consistency in sentencing and the opportunity for a focused and informed debate on sentencing provided by the work of the Sentencing Commission Working Group on the potential for a structured sentencing framework; and further welcomes the reforms which have been made to the youth justice system including the strengthening of alternatives to custody".
	As the hon. Member for Arundel and South Downs (Nick Herbert) said, this is the third debate tabled by the Opposition on this subject in less than a year. No matter how many times one tries to compare what this Government have done on law and order with what previous Administrations did—yes, I shall make comparisons, as well as deal with what we are currently doing and what we will do in the future—our record stands up to any amount of scrutiny.
	Let us look first at crime.

Desmond Swayne: rose—

David Davies: rose—

Jack Straw: Before I take interventions, let us first look at crime. It was the former Home Secretary, the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) who admitted in this House that crime had doubled under the Conservatives—and indeed it had. Car crime doubled, domestic burglary doubled, violent crime went up by 170 per cent., and robbery went up by almost 400 per cent. Furthermore, the Leader of the Opposition, the right hon. Member for Witney (Mr. Cameron), was asked on BBC "News at Ten" on 23 April—I do not need the transcript, as I saw him say it, as did many others—whether crime had fallen under a Labour Government and he said "Yes, absolutely, absolutely." He was right to say that, because it happens to be true. Not only that—

Desmond Swayne: rose—

Jack Straw: I shall give way shortly to the Leader of the Opposition's Parliamentary Private Secretary, who is sitting there like some sentinel watching the performance on the Front Bench, so he can report back. Indeed, he is nodding with approbation.
	What the hon. Member for Arundel and South Downs forgot to mention in his litany of painting down the success of the police and other criminal justice agencies is that only today, Sussex police—his own local constabulary—have announced a 10 per cent. fall in recorded crime over a year. Those figures happen to be grounded on a consistent basis.

Edward Garnier: rose—

Jack Straw: Before I give way to a junior member of the Tory Front-Bench team I shall give way, as I said I would, to the man who really has power—the Leader of the Opposition's PPS.

Desmond Swayne: In the excellent performance by my hon. Friend the Member for Arundel and South Downs (Nick Herbert), he referred to an instruction, so will the Lord Chancellor confirm that it is genuine, and that it is indeed the case that days on the run can be counted as contributing to the number of days in custody? If that is the case, is it possible that if a miscreant were on the run for long enough, they might actually be eligible for compensation for having been detained beyond the length of their sentence?

Jack Straw: I am happy to reassure the hon. Gentleman that that does not apply to those who have escaped. That Prison Service instruction, to which the hon. Gentleman draws such extravagant attention, does not apply to escaped people or those who are in normal parlance "on the run". It applies exceptionally to prisoners who have been released in error. Before Opposition Members say that no prisoners are released in error, I was intending to draw to the attention of a wider audience later in my speech the fact that on one single day in August 1996, 537 prisoners were released in error.

Edward Garnier: rose—

Jack Straw: I am answering the man with the power, at the back. I will deal later with those of the lower orders, however learned they are.
	It says in my briefing that such releases are extremely rare. Well, that is true under this Administration, but it was not true under the previous one. The decision to override the time out when a prisoner has been released in error can happen only if agreed personally by the Justice Secretary. I have never seen such an application, and I might also add—hon. Members are welcome to check the record on this—that when Mr. Ronnie Biggs had been on the run and finally returned to custody, I insisted, as I continue to insist, that all the time he spent on the run should be deducted, notwithstanding his attempts to say otherwise, from the time he claimed to have served. He would have been out years ago had he not decided to go over the wall.

Edward Garnier: rose—

Jack Straw: The hon. and learned Member for Harborough (Mr. Garnier) wishes to ask me a question.

Edward Garnier: How very gracious of the Lord Chancellor to permit me to tug at his regal gown. I am honoured. Will the Justice Secretary condescend to tell us why, if crime has been reduced by such a massive amount under his Government, the prison population has gone up by 23,000?

Jack Straw: I think that is dead easy: the two might be connected. Some statisticians disagree. I do not claim that there is an exact statistical connection, but I do say that there is some connection between the fact that crime has gone down by a third and prison numbers up by a third. I can speak so far as my own constituency is concerned. The truth is that this an element of criticism by the soft side of the Tory party, and I hope that the hon. Member for New Forest, West is making a note of who is on that soft side: Harborough is certainly wet; Woking is even wetter; Dorset is even worse—

David Hanson: And Monmouth.

Jack Straw: No. Monmouth is on the other side, but we will come on to Monmouth in a moment.
	The two things are connected. Speaking from my constituency experience, I think that the fact that many more serious criminals are now locked up, and for longer, is a reason why crime there has gone down as much, if not more, than it has in Sussex. Indeed, I am proud to say—I hope that the hon. Member for New Forest, West will agree with me on this—that the two forces that are consistently top performers in terms of public confidence and crime reduction are Sussex and Lancashire. As I said, the fact that we are jailing more people is one reason for that. I look forward to the hon. and learned Member for Harborough digesting that.

Oliver Letwin: Will the right hon. Gentleman give way?

Jack Straw: Of course I will give way to another wet.

Oliver Letwin: I am very grateful to the Secretary of State for giving way. Does he regard the increase in the recidivism rate as another cause of his supposed reduction in crime?

Jack Straw: It has not gone up. I shall not quote the rest of the letter to the hon. Member for Arundel and South Downs—the part to which he did not refer—at length, but if we compare like with like—

Oliver Letwin: Oh!

Jack Straw: Well, we have to do that. Otherwise, there is no proper comparison.
	If we compare the type of offences, we find that the rate has gone down, which I drew to the attention of the hon. Member for Arundel and South Downs in the same letter, when I stated that proven adult reoffending has gone down
	"by 5.8 per cent. since 2000 against the predicted rate."

Nick Herbert: Will the Justice Secretary confirm that in that letter of 27 November he wrote to me:
	"An estimated comparison of re-offending rates, taking into account the changes made in 2000 and the correct base figure for 1997, would in fact show only a 1 percentage point increase in actual re-offending by ex-prisoners, 1997-2004."?
	Will he therefore confirm that he has admitted that reoffending rates have risen under this Government?

Jack Straw: I do not accept what the hon. Gentleman says. If we are looking at what is happening to trends— [Interruption.] We have to compare one cohort of prisoners with an accurate and similar cohort later on. That is not a cop-out; that is the truth.

Humfrey Malins: On reconviction rates, my mind goes back to the Crime and Disorder Act 1998, which introduced the much vaunted drug treatment and testing order—a brilliant solution to our problems! Does the Secretary of State know that in fact there was a 90 per cent. breach of those and an 80 per cent. reoffending rate—historically, terribly high—which is why they were simply dropped?

Jack Straw: The drug treatment and testing orders were reformed into a better and more effective system.  [Interruption.] I am making a serious point about community punishments to the hon. Gentleman, as he knows, because he served on the Committee that considered the 1998 Act. He complained then about the fact that the prison population was too high. It was 60,000. Lord alone knows what he is going to be complaining about tonight when it is 83,000. By definition, community offenders are not locked up and it is more difficult to deal with them. We have to see whether a particular approach works, and if it does not, to be ready to amend it. That is what we sought to do.
	Perhaps I can make a little progress after those diversions. As I said, crime is down by a third. I am glad that we agree about that, not least with the backing and support of the Leader of the Opposition. It includes violent crime coming down, and a record 140,000 police officers. The chances of becoming a victim of crime are the lowest since the British crime survey began its operation in 1981.
	Let us also compare our record with the system that we inherited. On youth crime, it was taking 142 days— 20 weeks—to get a young offender from arrest to sentence. That is now down to 60 days. The hon. Member for Arundel and South Downs criticises our record on prisons. I am very happy to compare our record with the record of the previous Conservative Administration.  [Interruption.] It is no good his saying that he does not want to do that, because it was some time ago. That Administration is the paradigm for the Conservative party today. Conservatives seek to quote its record selectively when it suits them.
	Hon. Members might want to use the noun "crisis" to describe the prison situation, but by God, there was a crisis for many years throughout the 1980s and 1990s. More people escaped from so-called secure prisons in a week in 1992 than escaped in the whole of last year. I am told that it got so bad that private secretaries would not bother to inform Ministers following each escape; they would tot them up at the end of the week.  [Interruption.] It is true.
	Throughout the 1980s and 1990s, prisons were beset by crippling riots. It was a rare month between 1982 and 1995 that police cells were not used, and in considerable numbers. On average in 1992, more than 1,000 prisoners were housed in police cells every night, and that was by no means a record. During one month a few years before that, 3,500 prisoners were in police cells in a single month.
	We had the early custody licence in abundance on a number of occasions, but they were disguised by the previous Administration, most spectacularly when Douglas Hurd, now Lord Hurd of Westwell, extended remission from one third to one half, releasing 3,500 prisoners—not 1,200—at a stroke, the effect of which continued for many years. However, the Conservatives did not volunteer to do what I did, which was to ensure, because I thought it was right to do so, that monthly independent figures were produced on their equivalent of the early custody licence.
	In 1984, Leon Brittan increased eligibility for parole for short-term prisoners. That doubled the number released early. In 1991, Lord Hurd's temporary measures were made permanent in the Criminal Justice Act 1991.

Dari Taylor: Will my right hon. Friend add two more statistics to those that he has given? One is the number of convictions during the late '80s and early '90s. That fell by a third. The second statistic is that crime trebled in the same period.

Jack Straw: I agree with my hon. Friend on the first statistic. As for the second, crime doubled in that period.

Dari Taylor: Not according to my notes.

Jack Straw: Well, okay. Some crimes did.  [Interruption.] My hon. Friend needs to sack the researcher.

Mark Pritchard: I know that the Minister always likes to be accurate with the House. He mentioned absconders or people who have escaped from prisons. Does he recall a written parliamentary reply to a question I tabled last week in which it was stated that there were 510 absconders from open prisons alone, never mind category A, B and C? He might want to set the record straight.

Jack Straw: Of course I do. I think it was the answer to the hon. Gentleman's question in which I spelled out the difference between escapes, which is the correct term to use for closed prisons, and absconds, which are from open prisons, where people are free, by definition, to walk in and out because an open prison is open; it is a halfway house, as they call it in the United States. As it happens, the record in that respect is very good as well. In 1996-97, there were 1,115 absconds. That was cut by more than 50 per cent. by 2007-8. The question for Conservative Members is this: are they saying that in the unlikely event of their gaining office they will close all open prisons, or are they saying that if they keep them open there will be no absconds?

David Davies: rose—

Jack Straw: I will give way to the hon. Gentleman, as I promised to do so earlier.

David Davies: I thank the Secretary of State for giving way, not least because my constituency contains an open prison from which numerous very dangerous prisoners, including child rapists, have escaped or absconded. Whatever the difference is, it is not important. Is it not the case, however, that under the Government that the Secretary of State represents, people are trying to break into prisons to sell drugs and to prostitute themselves?

Jack Straw: The hon. Gentleman knows that to be nonsense, but may I say how pleased I am to see him in the Chamber? Like an awful lot of Members on both sides of the House, when I received the message that a "David Davis" had decided to resign, I thought it was him. It was a great relief to us all—except, I think, the Leader of the Opposition—to discover that he is still here, young and vigorous, and that it is the other "David Davis" who has decided to go off on a frolic of his own.
	Let me now return to the subject of the increase in the number of prison places. We have delivered more than 23,000 additional places since 1997, at twice the rate achieved by our predecessors, along with a commitment to increase the total to 96,000 net and 101,000 gross by 2014. There is some flexibility in the system.
	The hon. Member for Arundel and South Downs asked about the building programme. All the evidence that I have suggests that it is well on time and, in some cases, ahead of time. I am not sure where the hon. Gentleman's information originated. Over the past 12 months 2,422 places have been delivered, and we plan, and fully expect, 2,700 to be delivered in this calendar year. It is also a great credit to the Prison Service that not only is it delivering those places but—here I touch wood—in 11 years there have been no category A escapes.
	We have a responsibility to provide enough prison places for those who the courts determine should be there. Prisons are first and foremost places of punishment and public protection, but they are also places of reform, which means ensuring that there is a constructive regime that gives people on the inside a better chance of going straight on the outside.
	Prisons are not cushy. I was glad to note that the hon. Member for Arundel and South Downs told a recent CBI conference:
	"I do not believe that prisons are holiday camps or that prisoners largely want to be there".
	Perhaps he will talk to his hon. Friend the Member for Monmouth (David T.C. Davies). It is nonsense to suggest that prisoners want to be in prison, nor should they want to be there, because, as I have said, the purpose of their incarceration is first and foremost punishment.
	Prison regimes have been hugely improved since, in particular, the 1980s and early 1990s. Reoffending rates have fallen—I would be happy to write to the hon. Member for Arundel and South Downs about that—and we have provided more opportunities for rehabilitation. My right hon. Friend the Minister of State will tell the House later about the new offender compact that he is developing. There has been a tenfold increase in spending on drug treatment programmes, and the number of people failing mandatory drug tests has fallen by two thirds.

John Battle: Armley remand prison in my constituency has received welcome investment under the present Government. Its staff do a brilliant job in difficult circumstances. However, will my right hon. Friend give serious consideration to a proposal from the former chief inspector of prisons, Lord Ramsbotham, for what he has described as academies, by which I think he means practical, positive, small residential units to give the 3,000 young offenders in Britain a better chance to obtain the training and early intervention that will prevent them from reoffending? If my right hon. Friend would like to pilot one in Leeds, that would be most welcome.

Jack Straw: I always take Lord Ramsbotham's suggestions seriously, and I would be happy to talk to him and to my right hon. Friend about this one.
	As there has been a debate about the number of people under 18 in prison, let me say that it has been stable in recent years. The number of people whom we would describe as children—12 or 13-year-olds—in secure custody is tiny. There are seven 12-year-olds in custody, not the hundreds implied by some lobby groups, and they are there because they committed very serious offences. The bulk of those under 18 who are in custody are 16 or 17.
	We have worked hard to improve the regime for those people. That is a matter for the Youth Justice Board, which provides more resources per head. Staffing levels are higher and so is the standard of the regime, but it is always open to improvement. We are dealing principally with offenders for whom the custody bar is much higher than it is for adult offenders, because they have committed either many more offences or more serious offences.
	They often have intractable problems, frequently including emotional and learning difficulties. It is hard to turn them around, but we have to keep trying.

Bernard Jenkin: On the prison building programme, does the Secretary of State accept that even if the so-called titan prisons are built on time, on the basis of the current figures he is planning that they should be more than 30 per cent. overcrowded? As he has not produced any cost-benefit analysis, what evidence does he have that these are the most efficient way of providing new prison places?

Jack Straw: In prisons, there is always—and there will always be under any Government, in my opinion—a level of what is described as overcrowding, which is the amount above what is called normal capacity. I can conceive of no Government deciding to increase prison places by half the number of prisoners. Regardless of whether they are categorised as overcrowded, all but a few current prisons are very different from those of 20 or 30 years ago.
	The large prisons will not be warehouses, and it is ridiculous to suggest that they will be. They will be prisons within prisons. There is a good deal of evidence to show that they will be more cost-effective. It is easy for the Conservative Front-Bench spokesman blithely to assert that instead of building one prison for 2,500 on a footprint of 50 acres or hectares, it would be easier to build five prisons of 500 places. Would that we could. What happens the moment that we try to build prisons, for example at Beam Reach in the constituency of the hon. Member for Hornchurch (James Brokenshire), or in South Suffolk where there is also a suggestion that a prison should be built—and in both places land is available? What happens is that we do not get co-operation from the local Conservative Members; instead we get opposition, with the hon. Member for South Suffolk (Mr. Yeo) saying they will not have any more prisons in that area. We face a problem, therefore. I understand why the public are always unhappy about a new prison being built—although they are equally unhappy about a prison closing once it has been built. However, the truth is that this appears to be a cost-effective way of delivering this number of places on time.

Simon Burns: Will the Secretary of State give way?

Jack Straw: If I may make some progress, I will try to give way to the hon. Gentleman shortly.
	We are also clamping down on the supply of drugs into prison, and as I said to the House last Tuesday I will publish the Blakey report and our response shortly. We have also greatly increased training arrangements in prison and we are trying to do a great deal more.
	Managing the criminal justice system is not easy. It requires professionalism on the part of the prison and probation services, and I hope that all Members will join me in paying tribute to their staff at every level. It also requires consistency of approach. When asked about home detention curfew, the hon. Member for Arundel and South Downs skated over whether the Conservatives would abolish it.  [Interruption.] Perhaps they would not abolish it; perhaps he would like to clarify this?  [Interruption.] Well, I heard him being asked about it, and I remind him that in the then Home Affairs Committee the hon. Member for Woking (Mr. Malins) was in unity with the hon. Member for Aldershot (Mr. Howarth) in welcoming the home detention curfew initiative in what became the Crime and Disorder Act 1998. The Conservatives did not vote against the extension of home detention curfew on Third Reading of the Bill that led to that Act, nor did they vote against the extension of HDC in 2003.
	The hon. Member for West Chelmsford (Mr. Burns), who watches for the Leader of the Opposition, ought to be aware of the following quotation in respect of a new appointment by his leader. On the extension of HDC, a Conservative Member said:
	"The Minister reassured me about certain things that concerned me, for which I am grateful. I was aware of the low level of revocation of licences for those on home detention curfew. Therefore, the official Opposition will not be voting against the measure".
	That was said by a then junior spokesman who is now a highly elevated spokesman: the new shadow Home Secretary, the hon. and learned Member for Beaconsfield (Mr. Grieve). Since the scheme was introduced, with the approval of that Committee and of the Opposition, officially in 2003, 151,000 prisoners have been released, 85 per cent. have completed their period of HDC successfully and 4 per cent. have reoffended while on the scheme.
	The hon. Member for Arundel and South Downs devoted a significant part of his speech to the end of custody licence—ECL—which was introduced in June 2007 to create sufficient headroom to allow for prison numbers to be managed safely. That involves taking out 1,400 prisoners at any one time, which contrasts with the 3,500 prisoners whom Douglas Hurd took out of the system in 1987. Let me put this into perspective.
	I said that the prisoners are released up to 18 days early—that is two and a half weeks before they would come out in any event. Although I acknowledge that someone who is a victim of a crime, in any circumstances, is 100 per cent. a victim, regardless of how unlikely the event, it is important to put on record the fact that the offending rate on the scheme is just 1 per cent., which is remarkably low.
	The hon. Gentleman spoke about the terrible murder of Amanda Murphy by Andrew Mournian, and nothing that I can say can be of any assistance to her relatives and friends. However, as the hon. Gentleman sought to make a point about ECL, it is important to put on record what the learned trial judge, the honourable Mrs. Justice Swift, said in sentencing that man for that terrible murder:
	"It is right that I should say that the fact that you were released early cannot, in my view, be said to have been causative of what happened thereafter. It is highly likely that the events that took place would have occurred whenever you were released."
	 [Interruption.] No, it is not all right; it is not all right in any circumstances.
	It is important that the hon. Gentleman makes accurate points. It was the learned judge in that case who, obviously without anyone's prompting, went out of her way to say that, in her judgment, whenever the offender was going to be released, as he was bound to be for his index offence, he would have committed that offence. As he says that people are released without any check on their circumstances and where they are going to go, I should tell him that they are released 18 days early with all normal arrangements, including supervision, that would apply, depending on their sentence length, were they released 18 days later.
	May I also say that we will end ECL when headroom allows? I was asked whether that would be in some month next year. I wish I could say with absolute certainty when we are going to end ECL, because I understand the public concern about it. We can predict with some certainty the rise in the number of prison places over the next year, but it is very difficult to predict, as would be the case under any Administration, exactly what will happen in respect of the rise—it will be a rise—in the prison population. Let us consider what happened in the past three weeks in relation to very short-term predictions. There was a sudden and quite unpredictable increase in the prison population of getting on for 350 last week. Very tiny changes in 300 to 400 courts across the country can lead to a big aggregate increase in the prison population. We are working extremely hard, with the fastest ever creation of prison places, and the moment I judge that it is safe to do so, we will end ECL.

Nick Herbert: Will the Justice Secretary confirm that the combination of the automatic early release of prisoners and the ECL scheme means that many prisoners are being released before they have served even half their sentence?

Jack Straw: The prisoners are released in accordance with the law. We have home detention curfew, and this was a matter for debate 10 years ago. The hon. Gentleman came up with some extravagant promises—I hope that the shadow Chancellor was listening if the Conservatives are serious about going into Government—when talking about minimum and maximum sentences. One of my predecessors as Home Secretary, the right hon. and learned Member for Folkestone and Hythe, went to enormous lengths, as will be recalled by the hon. Member for Woking and the hon. Member for Dorset North—

Oliver Letwin: West Dorset.

Jack Straw: West Dorset. Of course, how could I forget? The right hon. Gentleman went AWOL during the 2001 election.
	The right hon. and learned Member for Folkestone and Hythe went to enormous lengths to try to introduce a system of honesty in sentencing. He produced one plan, which was in the original Crime (Sentences) Bill in 1996, but he had to withdraw it because it was completely incoherent. He then produced another plan, which I was ready to implement when we came into government in May 1997, but that also turned out to be incoherent and would not have produced honesty in sentencing.
	Of course we should be explicit about the minimum and the maximum that any individual prisoner will serve, but the resource costs of what the hon. Member for Arundel and South Downs implies are huge, at a time when the shadow Chancellor keeps criticising us for spending at current levels and suggests that public spending under a Conservative Administration—were that ever to happen—would be much less. No one will take the hon. Gentleman's proposals seriously unless he can say exactly what the resource costs will be and where that money will come from.
	The hon. Gentleman also has to say who would decide, once a judge has determined that there will be a sentence of between two years and four years, whether two, three or four years are served. Would it be the court? I think the judges would like to have some control over that. Or would it be a prison governor? How would that work? Or would it be done by an additional layer of complicated bureaucracy for the parole board? Those are serious questions and the hon. Gentleman needs to answer them.
	The hon. Gentleman also proposed a sentencing commission. As I said on 5 December last year, and have repeated since, there is no suggestion that a sentencing commission—such as an upgraded Sentencing Guidelines Council—could or should ever be used to fetter judicial discretion or to manage the prison population down. The prison population will rise for the next 10 to 15 years according to almost any scenario one can foresee, and Parliament and everybody else accepts that.
	I listened carefully to what the hon. Gentleman said. Parliament does have a critical role to play in setting the framework for sentencing, and in deciding on the level of taxpayers' money to be spent on prison places and probation services that arise from that framework. That is nothing to do with linking individual sentences to the availability of resources. We make different judgments from those in the United States, which typically spends four or five times as much on prison places and has four or five times as many. We spend more per head than other jurisdictions in Europe, apart from Portugal. There is an argument for spending some more, and we are doing that, but we do not want to see either the low level of sentencing that some European countries have or the very high level that some states in the US go in for.
	We seek a formal mechanism whereby the impact of proposed sentencing changes is assessed by an independent body, which we would call a sentencing commission, so that Government and Parliament are properly informed about the decisions that they take and understand what resources will be necessary to deliver those changes. We do not seek a restriction on judicial independence, but rather much better information about the resource implications and consistency of sentencing. The fact that offenders in Surrey found guilty of an indictable offence in a magistrates court on an either-way offence have a 9 per cent. chance of being sent to prison, whereas in Bedfordshire it is a 23 per cent. chance, raises questions about consistency of sentencing and which approach is better. I am not saying that we should ever tell sentencers what to do, but we need to have the debate and for sentencers to be aware of it.
	There are already guidelines laid down by the SGC, which is chaired by the Lord Chief Justice, and that works well, but I want to build on that, not least to ensure—as many of the judiciary are aware—that there is much better information available to the judiciary. Rather than damning the report by Lord Justice Gage and his distinguished colleagues before even seeing it, the hon. Gentleman should await its publication. He was, if I might say so, tilting at windmills earlier. I do not want this—

Nick Herbert: I quoted the Bar Council.

Jack Straw: Well, as a member of the learned General Council of the Bar, I merely say that it is not always right. Sometimes it is a bit behind the times.
	I do not want this issue to be turned into a political football—the others, yes. I tell the hon. Gentleman, in case he has forgotten, that the key words I quoted about the nature of the mechanism were the exact words that he used in a speech he made in November last year.

Alan Beith: Will the Secretary of State explain why he said that whereas we do not want to go in the direction of the US, which has very high rates of incarceration, nor we do not want to go in the direction of European countries, which have either always had lower rates of imprisonment than we do or have moved to them, as Finland has? Where is the evidence that their method is less effective than ours? Does not the evidence rather point the other way?

Jack Straw: I am sure that the evidence in Finland is that that system is effective in Finland. I know Finland a little, and I can tell the right hon. Gentleman that our society in England, Wales, Scotland and Northern Ireland is just different. I happen to believe that there is a connection, as we debated earlier, between the fact that crime has gone down by a third and that the prison population has gone up by a third. I do not claim that there is an exact statistical connection, but we have had problems—we still do—with crime and disorder to a greater degree than Finland has. We need to develop solutions that are suitable for here, which would not necessarily suit Finland. We shall learn, of course. We always seek to learn, not least about how to make community punishments more effective. The Minister of State, Ministry of Justice, my right hon. Friend the Member for Delyn (Mr. Hanson), will say more about that later.
	The first responsibility of any Government is the safety and security of the public. This debate has been about the challenges that we face in meeting those responsibilities. It is about how we punish and reform offenders effectively, improve reoffending rates and ensure that prison is tough, fair and constructive. It is about ensuring, too, that there are sufficient resources to meet the needs of the system. According to any analysis or comparison, we are meeting those challenges. Crime is down, and we are the first Administration since the war to achieve that. There is already a record increase in prison places and a record building programme over the next six years, and a big investment in the probation service to ensure more effective community punishments.
	The debate is also about a choice about a party that presided over a record rise in crime and whose economic policies, in truth, would lead not to more investment in the criminal justice system but to less, as they would across the public service. The choice is between the relative success of our approach and the unquestionable failures of theirs. I urge the House to support the amendment and to reject the motion.

David Howarth: I agree with the hon. Member for Arundel and South Downs (Nick Herbert) on one point—there is a crisis in the prison system. It has a record population of 83,000 and there are predictions, as we have just heard from the Lord Chancellor, of further increases. Overcrowding is increasing again. There is a breakdown in the capacity of the system to deliver rehabilitation programmes, which is causing chaos, especially in the indeterminate sentences for public protection—people cannot get out of prison until they complete their programmes, but there is no capacity to deliver those programmes. That leads to a situation that is unsatisfactory to the extent of being illegal.
	Prisoners travel up and down the country, sometimes effectively and sometimes not. In fact, I recently visited Bedford prison, where I was told that the equivalent of the entire population of the prison turned over once every 50 days. In those circumstances, delivering rehabilitation is near to impossible. In addition to that, reoffending rates are high. It is that crisis that has led to the use of early release schemes and home detention curfews. I think that the hon. Gentleman is right that those programmes are being used without proper consultation because of the need for speed and the need to deal with the crisis. However, I part company from the hon. Gentleman on the reason given in the motion for the crisis. In effect, the Conservative motion says that the crisis has come about because the Government did not build enough prison places, and will continue because the Government will not deliver extra prison places in the future. That is not why the crisis is with us; it is with us because the wrong people are in prison.
	My hon. Friend the Member for Teignbridge (Richard Younger-Ross) mentioned the mentally ill, and we might also consider the addicted. Some 70 per cent. of prisoners suffer from two or more recognised mental illnesses. Treatment must be the first priority. Yes, some of those people will have to be treated in secure facilities, but the first priority must be to help them, not to build new prisons. That is not the only issue; later in my speech I will talk about methods other than prison building—better methods—that could be used to prevent crime.
	The hon. Member for Arundel and South Downs mentioned one member of the Cambridge Institute of Criminology, Nicky Padfield. Let me mention another, Professor Friedrich Lösel, who recently wrote that with the right changes in policy, we could reduce the prison population by 30 per cent. and reduce crime. However, that would mean serious policy changes that would have to be implemented over an extended period. I will return to that subject later.
	First, I want to talk about the extraordinary statement in the first line of the Government amendment, to which the Lord Chancellor alluded. It is the line in which we are invited to welcome
	"the Government's record in cutting crime by a third",
	as though the Government could claim credit for the reduction in crime. I agree with the Lord Chancellor that there has been a reduction in crime, especially according to the British crime survey figures, although there has been a slight increase in recorded crime, but that is mainly in line with recorded crime figures across Europe. As he said, there have been a number of accounting changes that could easily explain that increase.
	There has been a fall in crime, and there are three things to say about that. First, the reduction started in 1995, not 1997. Indeed, since 1995, crime has gone down by way over 40 per cent., and there were bigger falls per year in the final years of the Major Government than under the Labour Government. The second point is that there are no obvious differences between the trends in Britain and the trends in other western developed countries. In Canada, for example, crime is at its lowest for 25 years and has also fallen by a third since the mid-1990s. According to the international crime victim survey, in France, crime has almost halved since 1995. The survey also shows that in the three European countries that have kept comparable figures for the longest, namely Britain, Finland and the Netherlands, the pattern of crime over 30 years has been near identical.
	It seems impossible to claim that the fall in crime is anything to do with this Government's policies. Indeed, it is quite difficult to claim that it has anything to do with any Government's policies. We are seeing the same pattern across the western world, which means that the fall must have more to do with social and economic conditions than with the details of Government policy in one country or another. Of course, this Government have form when it comes to claiming credit for global changes. They claimed the credit for improvements in the global economy.

Dan Norris: Is that why Liberal Democrat policy is not to imprison drug offenders?

David Howarth: That is not our policy. Our policy is to imprison offenders. If offenders happen to be drug addicts, they should receive treatment in prison, if prison is the appropriate sentence for their crimes.
	Let me return to the point about claiming credit. What will happen when those chickens come home to roost? Researchers have found an overall relationship between property crime and economic conditions. The Government have claimed the credit for reductions in property crime in times of economic prosperity, but will they bear the blame when those conditions change and crime rises? If they do, I will be surprised.
	The third point to make about the claim of the fall in crime since 1997 is that, since crime seems to have fallen nearly everywhere else in almost exactly the same way—except in Belgium, where something odd happened that no one can quite work out—Britain remains near the top of the list for the rate of victimisation. Some 22 per cent. of people are the victims of crime in this country in an average year, as opposed to 15 per cent., which is normal for the developed world. So it is true that the situation here is better than it was, but it is not good, and it is still not good compared with other countries.
	A more important question than whether there has been a general reduction in crime—a reduction in crime has happened everywhere—is whether we are doing as well as we could to prevent crime and to reduce reoffending, and it is not obvious to me that we are. Reoffending rates are extremely poor in Britain. The debate between the two Front Benchers was about whether the rates are worse or remain the same. The plain fact is that they are bad. About two thirds of offenders reoffend within two years. The reoffending figure is 73 per cent. for men between the ages of 18 and 20 who are given custodial sentences, and it is even higher for some sub-categories.
	By contrast, in countries such as Denmark, which is very similar in many ways to ours and very similar even in having only a slightly lower crime rate than ours—it is not in the category of countries, such as Portugal, that have very much lower crime rates—reoffending rates are astonishingly lower. In 2003, the rate was 27 per cent.

David Davies: Has the hon. Gentleman looked further into that research on reconviction rates and realised that the longer that people spend in prison, the less likely they are to reoffend and that the reoffending rate for people who spend four to 10 years in prison is about 33 per cent., which means that prison works?

David Howarth: I have heard the hon. Gentleman make that point in the past, but that figure is produced by the fact the people in that category commit very different crimes from the people in the categories that are given shorter sentences. However, he is right in one respect: we should be looking at what works to reduce reoffending. That is the crucial question. If prison worked in the way that he thinks it does, I would be prepared to think about it as a way forward; but, unfortunately, in general, it does not. Short sentences especially do not work.
	We know about a number of different ways to sentence offenders that work better. The most obvious one is restorative justice, whereby the offender is confronted with the victim and with the harm that has been done to the victim. Reconviction rates in restorative justice have been consistently found in scientifically controlled experiments to be much lower than when offenders are given other sentences. The difference varies between 15 and 26 percentage points lower—a vast improvement. It works even better for some more serious crimes than for less serious crimes. It also helps victims with the trauma and pain of being victims and helps them to overcome their experience. One of the big questions that those of us who have been victims of crime always ask is, "Why me?" Restorative justice helps to deal with that feeling. Will the Lord Chancellor state when we are likely to see the evaluation of the London trials of restorative justice, which he promised would be published this month?

Jack Straw: The evaluation was published on Monday. I am not trying to catch the hon. Gentleman out—he cannot be expected to be aware of everything that is published—but it was published on Monday to my virtually certain knowledge, because on Monday morning I went through the schedule of things that were due to be published, and it was one of them.

David Howarth: That is good news. I hope that the evaluation shows that restorative justice was successful in that experiment.
	I do not want to go through all the other possibilities on sentencing, but I must mention some of them. There is good empirical evidence that shows that specialist courts, such as drug courts, work. Some interventions outside the criminal justice system work, too. For example, early intervention has been mentioned, and it will reduce crime in the longer term. Even simple things such as teaching basic social skills to children and teaching basic parenting skills to adults work.
	Even after offending behaviour has been noticed, some evidence suggests that some forms of therapy work—for example, cognitive behavioural therapy works—but it is also true that other forms of therapy do not work. The important point is to act on what the evidence tells us. There are other ways in which we can act on evidence: hot-spot policing works; other forms of policing do not. There should always be room for new proposals, as long as they are independently evaluated and we work to the evidence rather than to the prejudices of the people who are advancing the ideas.
	The right hon. Member for Leeds, West (John Battle) is no longer with us, but he mentioned Lord Ramsbotham's suggestion of young offender academies. That idea is worth trying, because it would build on what we know helps to reduce reoffending. We know that reoffending is higher where offenders have no job, where they are homeless, where they lack close relationships and where they are addicted to drugs and alcohol. Aspects of Lord Ramsbotham's proposal attempt to deal with each of those problems and with other problems that we know on the evidence are related to success.

Richard Younger-Ross: Is my hon. Friend surprised that such proposals have been tried in the past? A particularly successful scheme, which taught young offenders crafts and furniture restoration, was tried in Wilton, but it was closed down under the Conservatives, who believed that short, sharp shock was a better policy.

David Howarth: That is certainly the case, and I will move on to discuss what does not work. Other approaches may work, such as community justice panels, which have been tried in south Somerset—there is some evidence that that approach is successful.
	We know that certain things will not work. Titan prisons have been mentioned, but the evidence suggests that they are unlikely to be successful. What do we know about unsuccessful interventions? Short, sharp shocks did not work; boot camps did not work; and there is increasing evidence that antisocial behaviour orders and tagging do not work. What do all those things have in common? They are all tough-sounding, popular and populist, but, most importantly, they do not work.
	The same is true to a large extent, although not to a complete extent, of prison. Prison is by far the most popular sentence with the public, the media and the hon. Member for Monmouth (David T.C. Davies), but it does not work, at least not in the way it is implemented in Britain. That takes us back to the question why our prisons are so ineffective compared with, for example, prisons in Denmark. The Government amendment boasts about the Government's prison-building programme, which is bizarre in a country where prison is so unsuccessful. That approach might make sense in another country where prison is more successful, but not here. So, the central point is that over the years, vast resources have been poured into policies that we all know do not work. It presumably happened because those policies, as my hon. Friend mentioned, are more popular than the policies that we know will work. So, what do we do? It is not enough to say that sentences must be tough if toughness means ineffectiveness. Effectiveness should be the touchstone of policy making, not toughness. But the issue is worse than that. If we put into ineffective policies public money that we could have put into policies that work and reduce crime, in effect we allow more crime than there would have been had we put the money into the right policies.

Alan Beith: I am reluctant to interrupt the careful flow of my hon. Friend's argument, but is not part of the problem the fact that some of the interventions that would work most effectively to prevent crime are completely outside the budgetary arrangement of the criminal justice system, residing in fields such as education, social services and the care system for children and young people? Effecting a transfer from the criminal justice system to those areas is something that our system seems congenitally incapable of doing.

David Howarth: It does indeed seem to be incapable of doing so, and that is one consequence of our system's over-centralisation. Once one places all the power in central Government, one ends up with such silos. It might be easier to undertake such work if we were to localise the system to a greater extent.
	The point that I was trying to make was that every pound that we spend on an ineffective programme as opposed to on an effective programme is a pound that effectively increases crime. That means that Governments in search of popularity have been responsible for there being more crime than there should have been. We need to think about the issue in a new way. Perhaps the way to put it is like this: those who fail to take effective action against crime and instead take ineffective action are objectively pro-crime; they allow extra crime to happen. That is precisely what we must stop. A consensus among politicians of all parties—I do not exclude my own from this—has brought us to this situation of crisis, record prison populations and unsatisfactory short-term expedients, such as early release schemes and the extension of home detention curfews. We must move away from that system of thought. We need a new consensus—within the bounds of morality and common decency—that is built around what works, because until we reach that new consensus, we will continue to suffer more crime than we need to.

George Howarth: May I begin by apologising to the hon. Member for Arundel and South Downs (Nick Herbert)? I missed the first few minutes of his speech, because I had other, inescapable business elsewhere in the House, but no discourtesy was intended.
	It is a pleasure to follow the hon. Member for Cambridge (David Howarth), not least because we share a surname. I take slight issue with one of the contentions in his speech. On reflection, he may care to rethink his position. He said that, basically, there seem to be no circumstances in which prison works. However, there can be a debate about what regime is most appropriate.

David Howarth: I did not say that. I was trying to point out that in different countries, prison works. In Denmark, reconviction rates are very low, and we need to think about why their prison system works far better than ours.

George Howarth: I am sure that there is no great difference between us, but I should make two points. First, manifestly, in one sense, prison at all times does work. By definition, anybody who is incarcerated is not at large to commit further offences. That is self-evident. The second point, which may be nearer to that of the hon. Gentleman than I am comfortable with, is that some regimes work better with certain kinds of offender than others, and we need to have a better understanding of how that process works.
	Part of the debate has centred on the Carter report and the working group chaired by Lord Justice Gage, which is considering that report's implications. I want at this point to make a confession. A Member of this House is a member of that working group—namely, me. I therefore need to be careful about what I say during the course of the debate. I would plead with the hon. Member for Arundel and South Downs not to prejudge the report that the working group will produce. There has been a great deal of thought and work on the part of all its members as to how they should proceed. I do not want to prejudge the report, as it is not yet fully written and no definite conclusions have been arrived at, but he may find some of its conclusions interesting—he may even find reasons to agree with some of them.

Edward Garnier: I am particularly interested in the right hon. Gentleman's response to the Secretary of State's assertion that Lord Justice Gage's working party may produce greater consistency in sentencing. Is it actively considering that, or is it only in the mind of the Secretary of State?

George Howarth: If the hon. and learned Gentleman will let me develop my speech, I may answer that question in a slightly different way, but I hope that he will recognise it when I come to it.
	It is important that I flag up some of the issues without arriving at definite conclusions from points that the working group has considered, which echo some of those made by the hon. Member for Arundel and South Downs. The first issue is judicial independence and whether anybody who managed a sentencing system would be in any way inimical to that. Under the current process, the Sentencing Advisory Panel and the Sentencing Guidelines Council have, to some extent, an influence on judicial decision making. There is still a lot of scope for those who decide on sentences to be able to decide within the ranges that are produced what is an appropriate sentence in an individual case. They are not tied down by the guidelines, but the guidelines must have some influence on the decisions that are arrived at. There is already an element of that in the system, if not to the degree considered by Lord Carter.

Edward Garnier: The right hon. Gentleman touches on an interesting area of conflict between the Executive and the judiciary. At the moment, the court of criminal appeal provides the sort of guidance that the Secretary of State and the right hon. Gentleman have been looking for. If the new body comes to fruition, it will be an executive body that provides yet another layer of "guidance" on sentences. Although there may be some variation in sentencing between magistrates court areas, does he not accept that the variations often reflect differences in local concerns? What may be an appropriate sentence for a crime in the Liverpool area, where a particular type of crime is prevalent, may not be necessary in another part—

Madam Deputy Speaker: Order. May I remind the hon. and learned Gentleman that interventions are meant to be brief? There are still a number of Back Benchers wishing to make a contribution to this debate.

George Howarth: The hon. and learned Gentleman is presumably aware that the Sentencing Guidelines Council already exists and is a long way along the road of publishing fairly comprehensive guidelines on a large variety of key offences. That process is already under way. The issue of inconsistency between one magistrates court area and another is complicated, and if I got heavily into that, my speech would take longer than it should. For certain offences, there has to be consistency. The hon. and learned Gentleman intervened; perhaps he would do me the courtesy of listening to the response. There are some types of offence—not necessarily those that will be heard in magistrates courts—for which it would be absurd if there were not consistency, particularly more serious offences, and I am sure that he would agree.
	The second issue that I wanted to mention concerns the data we have and how well we understand decisions taken in sentencing, whether in a magistrates court or a higher court by a judge. When they depart from guidelines, we need to know how they have arrived at a decision—whether it was by taking into account aggravating or mitigating factors. We do not have a great deal of data on that at the moment, and it is difficult to understand what is going on in such circumstances. The working group has conducted a survey of where there are such variations, and those interested in such matters may find its conclusions interesting. It is not complete yet, and the information has not been analysed, but I suspect that the information provided by that survey—probably the first of its kind—will be useful to all of us.
	The hon. Member for Arundel and South Downs mentioned the Minnesota model. Lord Justice Gage and some of the secretariat from the working group visited Minnesota and North Carolina, which have sentencing commissions. Without revealing too much of the thinking, it is understood that those two types of system are not appropriate for our judicial process. I do not think that it would be appropriate for me to go much further, but difficulties lie in the differences between the sort of legal system that exists at state level in the United States and what we have in this country. The hon. Gentleman need not concern himself overly with the comparisons that may be made between the two.
	My final point concerns the relationship at the heart of the discussion between the totality of sentencing decisions and the correctional facilities available, and how we arrive at a balance between the two. I probably have more sympathy with the hon. Member for Arundel and South Downs than I ought to about this, but at the moment we deal with the matter through a form of early release system. That is not unique to this Government; every Government have had to do it from time to time. In my view, that is entirely unsatisfactory because it means that decisions are fairly arbitrarily taken away from the courts. If a court decides that somebody should be sentenced in a given range, and an early release system of some sort kicks in, the offender does not serve the sentence in that range. That is unsatisfactory, yet we currently do that. It is certainly not the answer.
	The second method of dealing with the problem is providing sufficient headroom in the correctional facilities that are available so that, whatever the number of people sentenced, there will always be room. That is an attractive proposition, but is any Parliament, when determining the funds for social policies—health, education and so on—likely to vote sufficient funds to a prison estate that will be larger than anyone can predict to ensure that there is never a crisis in the prison system? I suspect that, if we are honest and realistic, that will never happen.
	There must be a system of balancing the two methods. Overcrowding is the other method that has been mentioned, but what constitutes overcrowding is a difficult debate to hold, and I should probably not follow that route, other than to acknowledge that it is one way in which to deal with the problem.
	I honestly believe that there is scope for changes that should attract a consensus in the House. I hope that the hon. Member for Arundel and South Downs and his colleagues will not prejudge the report of the working group, on which I serve. I hope that they will give it serious attention and accept that, although I sit on it, the group set about its work on a non-partisan, non-party political basis. I did not make my contributions on a party political basis. We have given the matter serious thought and I hope that those who read the report will recognise that, whatever its conclusions, it has been produced in a non-partisan spirit, in the hope of attracting some consensus.

Humfrey Malins: As always, I begin by declaring an interest as a Crown court recorder and a part-time district judge. Sentencing is an important issue and it is a pity that the debate is not longer, that it has not been better attended and that Opposition Back Benchers have 23 minutes between us to make our points.
	I speak from experience in the House and in the courts across London and the south-east. In the time available, I want to focus on sentencing, especially in relation to two crimes and our approach to them. First, I want to consider knife crime. We are in the age of the blade, and all hon. Members will have been horrified in the past few months by so many nasty knife crimes around London and other cities. Some have been mentioned tonight.
	I have been in court and listened to witnesses describe what it is like when somebody brings out a knife—the flash of steel, the terror, the legs turning to jelly; the evil of a knife when it is shown to one. I heard a troubling statistic when the Violent Crime Reduction Bill was considered in Parliament three years ago and I asked about knives in schools. I was told that, according to Government figures, some 20,000 children aged 11 to 16 carried a knife into school for offensive purposes and some 40,000 children aged 11 to 16 carried a knife into school for defensive purposes—60,000 children with knives in our schools.
	It was and is an horrific figure, and it should trouble us all tonight much more than anything else that we have heard. How can it be, in this age of the blade, that 60,000 children are taking blades into school? What about the children outside school, across the cities? How many tens of thousands are carrying knives? How many hundreds of thousands? If Government figures say that 60,000 children are taking knives into school, we are facing a true tragedy, but we have not got to grips with it.
	There have been far too few prosecutions. In 2005, only 73 youngsters were prosecuted for having a bladed article or offensive weapon on school premises. Only a modest amount received any form of custodial sentence. It is no wonder the public are in despair. Can someone not get to grips with knives in school? What are we going to do? The police and head teachers have plenty of powers already. Somebody, somewhere, has got to send out the message that it will not do for 11 to 16-year-olds and 16 to 18-year-olds to carry knives, and that it will be punished with custody.
	In debates on what became the Violent Crime Reduction Act 2006, I suggested a mandatory three-month sentence for such offences, unless there were exceptional circumstances. What happened? The Government rubbished my proposal, saying that there were probably not enough prison places. What summed up the Government's position at that time? I shall tell you, Madam Deputy Speaker. As I said in Committee, they had answered a written question, saying—can you credit this?—that
	"It is essential to educate young people about the dangers and consequences of becoming involved in criminality associated with weapon-carrying and the Home Office funds and operates a number of community-based initiatives aimed at encouraging good citizenship and turning vulnerable young people away from crime."—[ Official Report, 3 November 2004; Vol. 426, c. 300-301W.]
	Encouraging initiatives? Tell that to people on some of the estates that I have seen in London. We in this House must send the message that knife carrying among young people must be stamped out, and stamped out hard.
	I turn to my next point. Come with me to a court in south London, Madam Deputy Speaker, and look over at the dock. You see a man who looks 50 years old. He is scratching his arms. He is grey haired. He is stuttering. He is wobbling. He can barely lift his head. He is charged with stealing £60 worth of razor blades yesterday from a local supermarket. Why? To sell them, to get the money to buy his heroin. He looks a beaten man. He looks quite elderly. I ask him how old he is. He says 26. This is his 35th conviction in that court for a drug offence. He steals to fund his habit.
	When are we going to get to grips with the issue of drugs? Every heroin addict I have seen—and my God they come from some bad backgrounds; I shall say a word about that later—started with cannabis and solvents at the age of 11 or 12, and moved on to cocaine, crack cocaine and heroin. They are ruined at 26 years old. They have no self-esteem. They come from the most rotten estates.

Madeleine Moon: Does the hon. Gentleman not agree that this Government have done more than any other to help support people who have problems not only with drugs but with alcohol? I appreciate that there are not enough services in my constituency, but they are there and we are starting to tackle the problems faced by people with drug and alcohol problems who go on to commit crimes.

Humfrey Malins: Oh, if I had time tonight, I would tell the hon. Lady just where the Government have failed. She was not here earlier when we discussed drug treatment and testing orders—the great panacea—which were introduced a few years ago. Does she know anything about them? They collapsed—abandoned; failed—with an 80 per cent. reoffending rate and a 90 per cent. breach rate. Does she know that? She comes out with these platitudes about what the Government are doing here and there, but they need to do a lot more.
	What about the young man from the rotten estate, who has a Prozac-addicted mother and a violent father—alcohol, no self-esteem, no education, no job, nothing—and who has to be sentenced? He has drifted into heroin and we have got to get him out of it. It is no good sending him day after day through the revolving door of prison. That is no good at all. What we have to do is think constructively, which brings me to my last point on sentencing.
	We should think more about residential rehab for drug offenders. I have seen it; I know it can work; I have passed the sentence. There are no statistics showing how successful it is, but my goodness it can often be better than prison because sometimes these heroin addicts are victims just as much as criminals. Something has to be done. Prison costs £800 a week; residential rehab, on average, costs £675 a week. All around the country, these residential centres cannot get enough money; there is no money around. Yet the judges want to pass that form of sentence more and more.
	There are two further issues. First, on knives, we have got to do something rather than just talk about it and snatch a headline, which we can all do from time to time. Secondly, drugs are, in my judgment, the biggest evil that the criminal justice system has faced during the past 15 years. It is the thing that destroys most lives and ruins otherwise good young people. I repeat that we have got to take a more positive attitude.
	What is my last word? Cannabis. Sentencing on cannabis has been a joke for 25 years. "Smith, you are charged with possession of cannabis, how do you plead?" "Guilty." "Stand up. You are fined £50 and the drug will be forfeited and destroyed. Next case, please." Spare a thought for the next case, which is crossing a red traffic light—the penalty: £100. We do not take it seriously enough, early enough. That is my last comment.

Mark Pritchard: I am conscious of the time, so I shall be brief in order to allow my hon. Friend the Member for Monmouth (David T.C. Davies) to share his important thoughts with us. I congratulate my hon. Friend the Member for Woking (Mr. Malins) on making a speech that was brief, but also wise and thoughtful; he is a man of great experience and integrity.
	The Secretary of State was slightly embarrassed earlier when my hon. Friend the Member for Arundel and South Downs (Nick Herbert) reminded him of the record prison population—and rightly so, because overcrowding is unhealthy, it increases risk and is perhaps itself unlawful. My concern is for prison staff, as I believe overcrowding is increasing the number of assaults on them. It clearly causes great stress within these facilities. Indeed, prison officers are often going off work with stress, which in some cases leads to long periods of sick leave because of the extra pressures in overcrowded prisons. The Government have a duty to look after not only the prisoners but, perhaps even more so, the prison staff within their employ. They are failing to do that.
	I would like to focus on Shrewsbury prison, which is a major prison in Shropshire and the nearest to my own constituency. The prison provides accommodation for 181 prisoners, but the actual population, on the basis of figures released just a few months ago, is 329. That means an overpopulation of 182 per cent. Shrewsbury prison is the most overpopulated prison in England and Wales. That is a disgrace, not only for those seeking education and rehabilitation within the prison so that they do not carry on reoffending, but for the hard-working, committed and dedicated public servants who staff the prison.
	We heard earlier from the right hon. Member for Leeds, West (John Battle), but he neglected to tell the House that Leeds prison is currently 151 per cent. overpopulated. It is wrong that West Mercia police are being called upon time and again to act as full-time custodial officers, taking prisoners not only from Wales but from parts of the west midlands such as Wolverhampton. Once again, that is down to the neglect and failure of the Government. The right hon. Member for Knowsley, North and Sefton, East (Mr. Howarth) said earlier that he did not want to be partisan or party political—absolutely not, but it is interesting that those comments are made only when the Government are desperate for friends; when they do not need friends, they are very happy to be adversarial and partisan. On an issue of such importance, it is right that we bring the Government to account, as we are attempting to do this evening.
	I would like more thought given to the number of foreign nationals in our prisons. Of the 83,000 people now in prison, 11,000 are foreign nationals. We need a review to find out how we can get some of them to serve their sentences in their own countries, perhaps by having some financial arrangement with the home countries. I suspect that it would be less than the £30,000 a year that it costs the British taxpayer to fund prison places for each individual.
	We have heard about rehabilitation. It is absolutely right that we should try to get people off drugs and rehabilitated. I am glad that my right hon. Friend the Member for Witney (Mr. Cameron) is committed to having 20,000 extra drug rehabilitation places. I commend him for that. Education, libraries and access to learning are also crucial. Of course, as we have heard, all those are stagnating because of the current overpopulation of many prisons.
	The third sector—the voluntary or charitable sector—provides many answers to many of the problems discussed tonight. Yet the Government are not freeing up the organisations within it, and not giving them enough access to come into prisons to provide those valuable solutions that we all seek.
	I commend prison chaplains on their excellent work. I hope that political correctness, or pandering to certain minorities, does not mean that the Government put up barriers to their excellent work. I hope that the Minister of State, who is looking slightly confused, will go on the record as saying that he supports the work of prison chaplains, and that he would speak to any prison governor who tried to throw them out because of political correctness.

David Hanson: I support prison chaplains, and I support prison imams and people from all faiths who help in prisons.

Mark Pritchard: I hope that those words will be noted by any prison governors who believe that prison chaplains are not suitable for the modern prison.

David Hanson: If the hon. Gentleman can give me any evidence of that, I would welcome it and look into the matter.

Mark Pritchard: I am grateful that my fishing skills are still working. I am pleased that the Minister took the bait, and I will be happy to do that.
	We heard about bail hostels. My hon. Friend the Member for Arundel and South Downs (Nick Herbert) was right that ClearSprings needs to come clean about where it operates and the types of people within its hostels. I believe that there is one ClearSprings bail hostel in my constituency, and possibly three, but there has been no public consultation. There certainly has been no consultation with the local council. Why is it that yet again the Government seem to be putting the rights of criminals before the rights of law-abiding citizens such as my constituents? It is absolutely wrong.
	In conclusion, it is a great paradox that we have a Government who want to let out prisoners who we know have committed offences, but want to lock up British people who we know have not committed offences. They are failing in their first duty to protect British citizens and my constituents, and they have to get their act together.

David Davies: It is clear from what we have heard tonight that the current system of sentencing is nothing but a sham, a disgrace and a public confidence trick that has been perpetrated against the public for, in my opinion, far too long—for years, in fact, and in many ways it predates even this Government. At the moment, someone sentenced to one year in prison will spend about three months inside, someone sentenced to two years will spend about seven months inside, and someone sentenced to four years will spend just one year and seven months inside. Let us not forget that a four-year sentence is seen as a very serious sentence, and handed out only for crimes such as armed robbery.

Dari Taylor: Will the hon. Gentleman agree and accept, on the Floor of the House tonight, that the number of convictions fell by a third under a previous Conservative Administration, and that more people are in prison under this Government than was ever the case then?

David Davies: The hon. Lady is trying to do what the Home Office does—blind us with statistics. One of the reasons there are so many people in prison is the number of foreign nationals who were not here under the Conservative Government. If we look at the number of indigenous British people in prison, we see that the overall number is not much greater.
	This is yet another example of the way in which statistics are twisted and turned in an attempt to hide the fact that this Government are soft on crime and very soft on sentencing. Perhaps that is because they have swallowed too much of the anti-prison propaganda that has been emerging for far too many years from the Howard League for Penal Reform and many similar organisations—which, I might add, are not even prepared to debate the issues in public. Every time I receive an invitation to attend one of their conferences I write back, "Give me five minutes, give me three minutes, give me one minute, and I will stand up on the platform and prove that you lot are absolutely wrong." They never even bother to reply.
	The reason those organisations are wrong is that they talk about the costs of prison, which is an argument that we heard earlier this evening. Let us examine those costs.

George Howarth: Will the hon. Gentleman give way?

David Davies: I will give way in a minute, but the right hon. Gentleman should listen to this first.
	We spend approximately £2 billion imprisoning 80,000 people. A report produced by the Government back in 2000 suggested that the total cost of crime in our society was about £60 billion a year. In 2003 Lord Carter—another supporter of the Government, I believe—produced a report showing that 50 per cent. of crime in this country was committed by a hard core of 100,000 offenders, of whom only 15,000 were in prison at any given time. The other 85,000 were on the loose, presumably serving community sentences.
	The simple fact that we can deduce from that, using the Government's own figures, is that if we doubled the prison population from approximately 82,000 to approximately 160,000, removing the 85,000 people who are committing half the crime in the country, it would of course double the cost of imprisonment from £2 billion to £4 billion, but we could make a net saving of £30 billion for the taxpayer. That is the saving that could be made if we halved the amount of crime in the country. That means that prison is a bargain for the taxpayer, and the more prisons we can build the better.

George Howarth: I greatly regret the fact that the hon. Gentleman has been denied a platform for his views. Has he given any consideration to resigning and fighting a by-election on the issue?

David Davies: I assure the right hon. Gentleman that I do not intend to do that: I intend to go on fighting for what I believe in here. I can also assure him, however, that if I ever were to do it, a large majority in this country would support me. Anyone who has been a victim of crime believes that prison works, and prisoners do not want to go to prison. That is why all defence solicitors try to obtain community sentences for their clients.
	Community sentences are not tougher. I have seen them in action. I could tell stories of people serving so-called tough community sentences effing and blinding at staff, demanding that chips be brought to them because they cannot be bothered to queue. I have stood and watched that happen. I have friends in the police force who have seen people serving community sentences who have been unwilling to get off the bus because there is a light drizzle: they do not want to get wet because that would infringe their human rights. That is the reality of community sentences: they are not in the least bit tough, which is why all defence solicitors try to get their clients community sentences rather than prison sentences.
	The arguments about deterrence and reconviction rates do not add up. We know that the rate is about 60 per cent. in generic terms, whether people are serving a community sentence or a prison sentence, but if we break prison sentencing down, as I did earlier, we see that the longer prisoners serve, the less likely they are to reoffend. That is not simply because many are serving life sentences because they have committed murder. Those who are sentenced to between four and 10 years in prison are only 33 per cent. likely to reoffend within two years. The reason is simple: as any prison officer will confirm, those dealing with these people need a bit of time to work with them.
	This is where I suddenly become a bit more fluffy and  Guardian-reading.  [Laughter.] Yes, it is a bit of a shock, isn't it? There are things that I heard earlier with which I actually agreed. Many people who end up in the penal system come from very difficult backgrounds. Typically they have no education and no social skills, and they have drug and alcohol problems. We can all agree on that. But we will not help people like that by sentencing them to a year in prison and then letting them out three months later, returning them to the estates where their problems began.
	I do not have enough time to say more about this now, but I do not believe in throwing people into a cage and leaving them there. I believe that much more needs to be done in prisons to help those with drug and alcohol problems, and to give them the vocational skills—perhaps even academic skills in some cases—that will allow them to obtain jobs in the outside world. At the same time, I would be a little tougher and say, "If they're not prepared to take advantage of the opportunities that we must put in front of them, they don't come out of prison."
	It is obvious from the Government's own figures that prison works, that it is good for the taxpayer, that it is good for the victims, who get justice, and that it can also be good for the prisoners themselves. I commend my hon. and learned Friend the Member for Harborough (Mr. Garnier), who I am sure will be this country's next Justice Minister, for the work that he will do in building more prisons and putting more people who deserve to be there into prison, but also in helping those with serious drug problems to get help elsewhere, so they do not get wrapped up in the penal system.

Edward Garnier: This has been a short and overcrowded debate, and I am sorry that there has not been long enough for other Members to contribute—or for Members of my party to speak for longer, as in the limited time they have had there have been some stellar speeches. That demonstrates that my party, at least, has thought about the questions we face today.
	Before I deal with the motion and the Government amendment, I want to highlight a couple of points that have been made in the debate. It pains me—not very much, but somewhat—to have to say that the Secretary of State can never be accused of rising to the occasion. I am sorry that he is not present. I think he must be the only Cabinet Minister who is able to make an after-dinner speech well before dinner. It concerns me that he is able to treat a subject of such importance with such levity. I fear that the longer he remains in office, either as Home Secretary or as Secretary of State for Justice, the less chance we have of seeing a coherent strategic approach to the criminal justice issues that our motion describes. Let us hope that the Minister of State, who has thought about these issues with greater concentration, is able to sum up on behalf of the Government in more attractive fashion.
	The Secretary of State rightly said that the number of escapes from category A prisons is now down to more or less zero, but the real issues nowadays for security in prisons is not who escapes unlawfully from the custodial estate—the open estate is a different matter, of course—but what contraband gets in either over the walls or through visitors or prison officers smuggling stuff in. That statement gives me the opportunity to agree with Members who have paid tribute to those who work in prisons: prison and probation officers, those who work in the education service in prisons, and all those who work to keep the people whom the courts have sent to prison safe, in an attempt to rehabilitate and reform them so that they come back on to our streets, as many of them do, in a better condition and fitter to spend their time back in society, looking after themselves and their dependants and paying their way.
	That is not an easy task. I have visited more than 45 custodial institutions since I was appointed to this job, and I can assure anybody who doubts it that prisons are not pleasant places to work or live in. We have a Government who were prepared, through neglect, to allow Norwich prison, for example, to continue to be run in a state of filth, with sewage leaking out of the pipes and into the areas where prison officers had to work and prisoners had to live. When we have a Government who were prepared to allow that to go on—and to do so because they had so managed the system that it was overcrowded and they could not decant the wing in order to repair it—we have a Government of which I, and I think most civilised and rational people, despair.
	My hon. Friend the Member for Arundel and South Downs (Nick Herbert) set out the case that my party makes against this Government, and one looks to their amendment to see how they respond to that charge—one does not look to the Secretary of State's speech for that, because it did not provide the answer. The Prime Minister's amendment claims that we should welcome
	"the Government's record in cutting crime by a third, its provision of 23,000 more prison places since 1997, and its commitment to create a total of 96,000 prison places by 2014, demonstrating that public protection is at the heart of its strategy".
	One has only to examine the facts to see that violent crime, particularly crime involving knives and guns, has increased. The overall level of crime may have been reduced, but the public are rightly worried.
	People realise that our prisons are more overcrowded than they ever have been, and that the rise in the number of prisoners from 60,000 to 83,000 should not be a point of pride. It should be a point of shame, especially when one considers what is done for prisoners inside prison—nothing. That is not because the prison officers are not doing enough work or because the educationists are not doing enough to help, but because the Government have so overcrowded the prison estate that nothing meaningful can be done to assist in their rehabilitation.
	Until we can get reformed and rehabilitated prisoners who come out into society as useful citizens, the reoffending rate will remain as high as it is. Until we can do that, and until the point made so eloquently just now by my hon. Friend the Member for Woking (Mr. Malins)—he has made it before, but it appears not to have touched the consciousness of the Government—is drilled into the Government's brain, nothing will be done and this hopeless carousel of people appearing before him and before me when we sit as recorders and as sentencers will continue. Nothing will be done in terms either of the moral rightness of the case about which we complain or of public expenditure, and I congratulate my hon. Friend the Member for Woking on what he said.
	I also listened with great care to what the hon. Member for Cambridge (David Howarth) had to say. I did not go to Cambridge—I went to an older university—but I think that many who did, including perhaps my hon. Friend the Member for Arundel and South Downs, will have felt that the hon. Gentleman's speech was like a law lecture given in the faculty.

David Howarth: It was not that good.

Edward Garnier: No, it was not that good, but it was a thoughtful and constructive speech, I enjoyed listening to it and I hope that the Government will pay attention to it.
	I also found the speech made by the right hon. Member for Knowsley, North and Sefton, East (Mr. Howarth) thoughtful. The interventions that I made upon him were deliberately designed to find out more about the work of Lord Justice Gage's working party. I had not realised that the right hon. Gentleman was a member of it, but, having heard him speak, I am glad that he is. I take him at his word when he says that he is not interested in making party political points during its deliberations, because I am sure that he is not. I look forward with interest to reading the final recommendations of that working party, as I am sure we all do.
	None the less, I retain my concerns about the motives behind the setting up of the working party and about this dangerous collision point between the Executive and the judiciary—I leave aside the concerns that we have as parliamentarians—on the interference with judicial discretion on sentencing. Sentencing is about the most difficult judicial task that sentencers have to carry out, and although the sentencing commission might be set up for one purpose, we need to be extremely careful that it does not achieve another.
	My hon. Friends the Members for The Wrekin (Mark Pritchard) and for Monmouth (David T.C. Davies) were crammed in at the very last moments of this debate and, not for the first time, they made some powerful points very powerfully. Time does not permit me to speak sufficiently about what they had to say.
	It is not an idle boast when I say that the Conservatives are genuinely thinking hard about the issues that face us. The prison population is too high for the available capacity, and we want prisons to do what they cannot do at the moment: we want them to become places of education, hard work, rehabilitation and restoration. That would mean that prisoners who justly go to prison for committing serious crimes come out repaired, not only so that they do less harm to themselves, but so that they do real good to their families and those who live close to them.
	Some £11 billion is wasted in the criminal justice system on reconvicting people, and we want to unlock that money and use it to get people off drugs, to teach people to read and write and to make them employable. It really will not do for the Secretary of State and his Ministers to tell us how much money they have put into the system, if nothing comes of it.
	My hon. Friend the shadow Secretary of State had an exchange with the Secretary of State about the Prison Service instruction on those unlawfully at large. Again, I am afraid that time does not permit me to go into detail, but that is a live issue that the Secretary of State needs to resolve. The public cannot be expected to have any confidence in the criminal justice system if they get the impression that people who escape from prison and are unlawfully at large are rewarded, when they should not be.
	My 10 minutes are up, and I must not trespass on the Minister's time. I have much more to say, and I hope that the fact that I am bringing my remarks to a conclusion will not give the Government a chance to say that we have nothing to say. We have—it is in our paper "Prisons with a Purpose". I urge the Minister to read it, learn from it and produce policy on the basis of it.

David Hanson: We have had an interesting debate, which began with a fiery speech by the hon. Member for Arundel and South Downs (Nick Herbert), who raised several points that he has made on other occasions. Speeches from Back Benchers ended with a particularly fiery one from the hon. Member for Monmouth (David T.C. Davies). We do have several anger management courses in prison in which he could participate if he so wished. We also heard, as the hon. and learned Member for Harborough (Mr. Garnier) pointed out, some thoughtful speeches, not least from the hon. Member for Cambridge (David Howarth), my right hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) and the hon. Member for Woking (Mr. Malins). This last raised the serious issues of knife crime and drugs. I hope I will have time to address some of those issues in some depth, if not to the complete satisfaction of Members.
	As my right hon. Friend the Secretary of State said, the Government have a good record on prisoners and crime. The chance of being a victim of crime is at its lowest level for 25 years and more offenders are being brought to justice. Reoffending rates have also fallen significantly, but we face real challenges that we must address as part of our work on prisons. Members have raised the question of prison numbers and how we can address reoffending. The hon. Member for Cambridge raised the important issue of who we put in prison and whether we need to consider reoffending in a new way. The hon. Member for The Wrekin (Mark Pritchard) also raised the key issues of foreign national prisoners and the need to protect and support our prison staff.
	I certainly echo the tributes paid by the hon. and learned Member for Harborough to the important work done by prison staff. He also drew attention to the need to support that work and to protect the safety of staff. That is why I take exception to the points made by the hon. Member for Arundel and South Downs when he accused staff of simply warehousing prisoners. That is not the case, nor is it part of our overall plan to tackle offending and reoffending.
	My right hon. Friend the Member for Knowsley, North and Sefton, East mentioned the need to consider sentencing balance, and he set out an important set of principles and topics for discussion. He said that he had not yet reached conclusions, and my right hon. Friend the Secretary of State and I give a commitment to consider his conclusions positively when they are produced.
	The issue of prison places was central to the debate. We provided 1,700 new prison places last year, and 2,422 to June this year. When the hon. Member for Arundel and South Downs says that the Labour Government have failed on prison places, I remind him of the fact that since March 1,240 prison places have been delivered. When he goes, as I hope he will, to visit Stoke Heath, Erlestoke, Albany, Send, Ranby, Lewes, Portland, Stocken, High Down, Blundeston, Wandsworth, Brinsford, Acklington, Kirklevington Grange and Wayland, he will see new prison places tackling the new prisoners who are coming in to those places because we are bringing more offences to justice. I hope we will bring forward more prison places before the end of the year.
	The difference between the Opposition and the Government is that we have put £1.2 billion of new money from taxpayers' resources into the system in this comprehensive spending review settlement. We will put in a potential further £1 billion plus in the next comprehensive spending review—money that I venture to suggest the hon. Member for Arundel and South Downs would rather put into tax cuts than into public spending and public services.
	Important issues about preventing reoffending were mentioned by the hon. Member for Cambridge and others. It is important that, as the hon. Member for Woking suggested, we look at what we do about drugs and drug dependency. It is important that we do that in the community through better use of community sentences, and that we invest in services in relation to drugs in prison. The hon. Member for Monmouth mentioned drugs in prison, too, and I remind the House that Mr. Blakey, a former member of Her Majesty's inspectorate of constabulary, has produced a report for my right hon. Friend the Secretary of State on drugs in prison, which we intend to publish shortly. It considers how we can improve the regime in prisons and the community.
	The question of employment and raising the levels of literacy and skills was mentioned by the hon. Member for Cambridge and is absolutely vital. It is not just about putting people in prison for punishment, although punishment is extremely important but was lacking in the hon. Gentleman's speech. It is equally important what we do with people when they are in our system.
	We certainly have to do more work on education, raising literacy and numeracy and securing support for employment and training. That was why I was particularly keen only last week to join my hon. Friend the Member for Tooting (Mr. Khan), the Government Whip on the Bench today, in a visit to Wandsworth prison where we saw key examples of training in computers, literacy and cabling. We are working with private sector employers from outside Wandsworth prison and with the Under-Secretary of State for Innovation, Universities and Skills, my hon. Friend the Member for Tottenham (Mr. Lammy), who is also on the Front Bench today, to look at how we can link employers outside prison with offenders in prison to raise their skill levels, get them into employment and ensure that they have the opportunity to change their lives on their exit from the prison system.
	As was mentioned, we also need to look at whom we put in prison. Members will know that we have commissioned my noble Friend Lord Bradley to look at the issue of mental health. He will be reporting shortly to the Under-Secretary of State for Justice, my hon. Friend the Member for Liverpool, Garston (Maria Eagle), the Secretary of State and me on the question of mental health interventions and whether or not we can find alternatives to prison for certain prisoners who have mental health issues. We are also putting in place a range of provisions to consider cognitive behaviour programmes and the need for offenders to complete additional work on those issues.
	The hon. Member for Woking also mentioned the important issue of knife crime. I take his points extremely seriously. He will know that we have doubled the maximum prison sentence for possessing a knife in a public place to four years and that we have given school staff extra powers to search pupils for weapons. We have banned samurai swords and supported increased stop-and-search powers for police. Indeed, with my right hon. Friend the Home Secretary we have recently introduced 100 portable knife arches and 400 search wands. Knife crime is a serious issue. It does not affect every community in the UK, but those that are affected are affected very seriously. I take very seriously the hon. Gentleman's points about what we need to do.
	The Labour Government are providing the resources for extra prison places, tackling reoffending and making sure that we reduce crime, as we have done over the past 11 years. I challenge Conservative Front Benchers to ensure that if their party formed a Government, it would provide the necessary resources. It would not do so; it would not tackle reoffending, as we are doing. I commend the Government amendment to the House and oppose the Opposition motion.

Question put, That the original words stand part of the Question:—
	 The House divided: Ayes 147, Noes 320.

Question accordingly negatived.
	 Question, That the proposed words be there added , put forthwith, pursuant to Standing Order No. 31 (Questions on amendments):—
	 The House divided: Ayes 280, Noes 184.

Question accordingly agreed to.
	Mr. Speaker  forthwith declared the main Question, as amended, to be agreed to.
	 Resolved,
	That this House welcomes the Government's record in cutting crime by a third, its provision of 23,000 more prison places since 1997, and its commitment to create a total of 96,000 prison places by 2014, demonstrating that public protection is at the heart of its strategy; further welcomes the Government's commitment to remove the End of Custody Licence Scheme when headroom allows; notes that the use of police cells is much lower than under the previous administration; further welcomes the tough and effective community sentences that have been introduced and the work done to increase public awareness of their role and effectiveness, and the further investment in intensive alternatives to custody to continue to build the confidence of sentencers in their effectiveness, as demonstrated by significantly reduced re-offending rates; notes in respect of the Bail Accommodation and Support Service that ClearSprings is required to consult the police, local authorities and probation to avoid inappropriate property locations; considers that there should be greater consistency in sentencing and the opportunity for a focused and informed debate on sentencing provided by the work of the Sentencing Commission Working Group on the potential for a structured sentencing framework; and further welcomes the reforms which have been made to the youth justice system including the strengthening of alternatives to custody.

PETITION

Post Office Closures (Staffordshire)

David Kidney: Some 578 people who live in or near the village of Great Bridgeford near Stafford have signed this petition to save their post office from closure as part of a community-wide campaign to keep the post office as part of their community.
	The petition states:
	The Petition of residents of the village of Great Bridgeford in the Parish of Seighford and surrounding areas in the county of Stafford against the closure of their rural post office,
	Declares that the supporters recognise the importance of the post office and shop to their community, which they depend on as the only retail outlet in the village of Great Bridgeford, and oppose the current closure plan.
	The Petitioners therefore request that the House of Commons urges the Secretary of State for Business, Enterprise and Regulatory Reform to instruct Post Office Ltd. to keep Great Bridgeford post office open.
	And the Petitioners remain, etc.
	[P000214]

PFI CONTRACTS

Motion made, and Question proposed, That this House do now adjourn.— [Mr. Roy.]

Ian Liddell-Grainger: I am grateful for the chance to introduce this debate. Before I go into detail, it is my duty to declare two specific and important interests in this matter. First and foremost, I am obviously a Conservative, and it was the last Conservative Government who introduced the private finance initiative in 1992. I have absolutely no objections whatsoever to well-planned PFIs. They make good financial sense, the risk capital comes from the private sector and a decent cut of any reward is designed to end up in the public purse. The Treasury measures success by the simple yardstick that PFIs must be fair, and above all, accountable. They have a highly detailed standard contract procedure, which is understood by all parties. Private finance initiatives have their critics, and things can go wrong, but they are the most tried and trusted example of private partnerships.
	My second declaration of interest is much more important. I have a financial stake in the private partnership that we are considering. I live in Somerset and pay taxes to Somerset county council. I have thus become a small shareholder in a huge new joint venture, brokered by the county and run by the global computer giant, IBM. The company is called Southwest One.
	The Under-Secretary of State for Communities and Local Government, the hon. Member for Gloucester (Mr. Dhanda), will be familiar with many of my concerns because we have discussed the matter privately and in this place. He listened to my speech in Westminster Hall on 26 March on the subject, and I thank him for his response to it. During that debate, I clearly expressed my anxieties about the way in which the company came into being. I feared corruption, and I made that clear at the time. I can prove that lies have been told and, tonight, I will produce fresh evidence.
	I should like to make one thing crystal clear. Some have wrongly accused me of sheltering behind the protection of parliamentary privilege. That is incorrect. I have repeated outside everything that I have ever said about Southwest One here. My website and my blog—modesty forbids, but it is called Mogg the Blog—bear ample testimony to that. I have laid myself open to any legal challenge and, as yet, no one has dared challenge me.
	Southwest One is formed of two councils—Somerset county and Taunton Deane borough—plus one police authority, Avon and Somerset constabulary. I remind the House that its business partner is IBM. Hon. Members will be surprised to learn that IBM owns 75 per cent. of the company. That means that, if Southwest One ever makes a profit, the "Big Blue" will pocket three quarters of it. It is a 10-year venture, which was supposed to save money. Somerset council claims that it will save it £200 million—£20 million a year. Yet the county offers no logical explanation or business realisation plan. Why? There is not one.
	There is a document, which falsely describes itself as the business realisation plan, but it contains not one single fact or figure. Instead, it is an exercise in vivid imagination, probably written by—dare I say it, and show my venerable age—Andy Pandy. Let me give an example. The document states:
	"Improved supplier service levels will result in authorities delivering higher performance."
	Excuse me—what is the precise predicted improvement year after year? We do not have any numbers—but there are no numbers. It is all aspirational garbage.
	When did the document appear? Only the other day, after persistent demands under the Freedom of Information Act 2000 from angry trade unionists. I pay tribute to Unison, which has not stopped its campaign. As a taxpayer and Somerset Member of Parliament, I share its anger and frustration. I gently say that I hope that the Minister does, too. It is no way in which to conduct intelligent business.
	The Government already rightly publish excellent advice on how to do things. Business Link describes best practice thus:
	"Success in a joint venture depends on thorough research and analysis of aims and objectives. This should be followed up with effective communication of the business plan to everyone involved."
	However, the architects of the joint venture company have strangled information to such a tiny trickle that nobody outside the magic inner circle knows what is going on.
	Not one elected councillor of any persuasion has been given unrestricted access to the 3,000 page contract, which was signed last September. Most of it stays hidden. Councillors, the unions and the public who, like me, pay for all that, have been treated like mushrooms. We have been left in the dark and, every now and then, some smug soul chucks a bucket of manure over us. The last big bucket of dung was delivered yesterday by the very man who boasted that not a single job would be put at risk by the deal.
	As the Under-Secretary knows, I am talking about the chief executive of Somerset county council—a man who has lied consistently to everyone at all stages. Yesterday, he calmly told an audience of more than 200 councillors, almost in a throwaway line, that restructuring services throughout Somerset would probably mean a 30 per cent. cut in the total work force. That would mean Somerset county shedding 5,000 jobs in front-line services and almost 200 each for the five district councils. However, some of those councils do not employ 200 people directly.
	Mr. Jones was not authorised or expected to say what he did; it just slipped from his lips like a blob of saliva. He is a man who claims to be guaranteeing the jobs in Southwest One, but he has now told us that thousands of other jobs will be sacrificed by the people of Somerset. That is the ultimate betrayal, and the unions and others now call him Alan "Judas" Jones. The current leader of the council, Jill Shortland, is trying tonight to explain away his words, by claiming that any job losses can be achieved by natural wastage. But the only natural wastage that most people want to see is the immediate departure of that incredibly dangerous man, who has cocked up and covered up for far too long.
	We do not even know for sure who is on the board of Southwest One. There are quite a few bods from IBM, naturally, and a couple of harmless councillors who would not say boo to a goose or recognise a balance sheet if it bit them, like a goose, on the bottom, as well as the chief constable of Avon and Somerset police force, who apparently has the right to sit on a public board. I do not think that I have heard of an arrangement quite as dodgy as that. I am also reliably informed that the chief executive of Somerset county council is another regular attendee at board meetings, but that is hearsay. Mr. Jones has always sworn blind that he plays no active part in Southwest One. I am afraid that that now looks like another whopping lie.
	I intend to dwell on Mr. Jones for quite a while. He more than any other public official has been involved in the formation of the company, and it is his ruthless tactics that we must expose. Mr. Jones has a habit of falling out with people and then covering it up. The first effective manager of ISiS—the improving services in Somerset programme, which was the precursor to Southwest One—was a bright and attractive young lady called Jenny Hastings, a constituent. She and Mr. Jones worked effectively and closely, but then there was the falling-out.
	All councils have a procedure for resolving grievances—we all know that; we are Members of this place—but in that case there must have been something extremely difficult to resolve. The timing was uncomfortable. The Audit Commission was about to examine the county's books. Somerset's quest for five shining stars would have fallen flat on its face if the chief executive had been embroiled in a tacky public industrial tribunal. It took the services of ACAS to thrash out an agreement, under which Mrs. Hastings departed amicably—and silently.
	The process also cost an awful lot of public money. I would like to know how much. I made a request under the Freedom of Information Act 2000 more than a year ago, but the council is still dragging its feet and delaying a response.
	Mr. Jones's reputation in county hall is a legend—a remarkable achievement. I am told by the unions that anthrax is more popular than Alan Jones, but I would not know personally. I am no friend of the Liberal Democrats—the Minister knows that, and you certainly do, Mr. Speaker—who hold political control, but I am appalled and horrified by the manner in which Alan Jones manipulates them. There is no better example of that than what happened to one councillor, who was the deputy leader of the Liberal Democrats on the county council.

Chris Ruane: Name him!

Ian Liddell-Grainger: I thank the hon. Gentleman—that councillor's name is Paul Buchanan. As Liberal Democrats go, he has the sharpest of brains. He was on the ISiS project, he worked with Jenny Hastings and he knows where all the bodies are buried. He has made no secret of the fact that Alan Jones would be out if he became leader, which he was destined to do. Unfortunately, that claim may have been a bit of an error. Last April, Alan Jones reported Paul Buchanan to the Standards Board for England—no fewer than 50 different trumped-up charges were made against the man.
	I sit on the Select Committee on Public Administration, but I am afraid that I do not have a high opinion of the Standards Board for England. The Government's motives for creating it were sound, and rightly so. After all, we must expect high standards of all our elected councillors and elected representatives. However, the Standards Board system allows injustice.
	Alan Jones was able to make those absurd complaints, and because of the way the board is set up, it is obliged to take them seriously, regardless of their nature. As a direct result, Jones silenced his most powerful internal critic. Suddenly, anything and everything that Councillor Paul Buchanan might have been able to say fell under the cloak of sub judice. That scuppered his political chances as well—conveniently. Irrespective of political persuasion, nobody wants a new leader with a shadow of an investigation hanging over him, so the Liberal Democrats ditched their best man, and little Mr. Jones must have relished every second of it.
	The original 50 charges, incidentally, were rejected very quickly indeed, but Jones, as usual, came back with fresh new charges. Inexcusably, the Standards Board is still wading through them. This dreadful system has permitted a brutal injustice in order to protect a dangerous unelected megalomaniac as he pursues the goal of a high-risk and very dangerous private partnership.
	I am now in a position to prove that one high-level official in county hall acted in support of the chief executive and gave false testimony to the Standards Board. The Secretary of State said in March, and the Minister repeated it in my Westminster Hall debate, that I should take up my concerns with the district auditor. I thank the Minister for that advice; I have done so. However, I am sad to report that the district auditor considers my evidence outside the strict remit of his accountancy, so I have no option other than to call in the Serious Fraud Office.
	I am also concerned about the involvement of Avon and Somerset police in all this. Alan Jones hired the wife of the chief constable to negotiate directly with the preferred bidder, IBM. Now the chief constable himself has the right to sit on the board. I believe that that is too close for comfort and sets a dangerous precedent. Mr. Jones is now beginning to admit some of the ghastly truth about this deal. It will lead to job cuts. Even the police—Avon and Somerset constabulary—are talking seriously of shunting and shredding the front-line office staff in 19 police stations across the force area. The Minister is based in Gloucestershire and I am sure that he would have something to say if his police force were affected.
	Southwest One is currently trying to drum up extra trade in Essex, Torbay, Plymouth and Cornwall. Cornwall is becoming a unitary authority and I would say to that council, "Please look carefully at what you are doing; you are being led by the nose; if you go down this line, your expenses, accounts and accountability will be given to IBM based in Southampton". The same goes for Plymouth. They are both good councils; both need, dare I say it, guidance away from this mad scheme. I think that they should be afraid; they should be very, very afraid.
	The ethos of Southwest One is cut-price. The figures do not add up because there are no figures to see. If the other authorities sign up, they will be recklessly risking public money, but this is the way that IBM likes to do business: cutting margins, cheeseparing, getting less for more. The more it makes, the more it takes. Remember that IBM owns 75 per cent. of the action. New software arrives soon; it is called "SAP", but everywhere SAP has been sold to local government, there have been huge operational problems and big costly overspends. That has happened in Bradford, it is about to happen in Somerset and we are going to pay through the nose for it as taxpayers and as local people.
	IBM put in the Rural Payments Agency computers, but we would have been better off with a bag of kiddies' counting beans than with the mess that was made there. I do not blame the Government; I blame the systems. IBM lost the Department for Transport £970 million—do not take my word for it; the National Audit Office nailed it a couple of weeks ago. IBM cares about only one client—IBM—but that is business, is it not? One has to be tough to flourish and picking a global partner requires similar expertise to be able to counter and understand what is happening. That is what is missing, and that is what I want to address.
	Councillors in Somerset have had to rely on reports from a small group of officers, unaccountable to anyone, whose future careers are entwined with Southwest One. Councillors have found it incredibly difficult to represent the public interest because they are not getting impartial advice.
	I have a handful of positive suggestions for the Minister to consider. When it comes to Government projects, it is mandatory for the 4Ps agency to do regular reviews. Why not extend that to local government? Just an idea. How about beefing up the Audit Commission so that it can handle these highly complex deals? Either that or allow the National Audit Office to do the job, which would of course come under the Select Committees of this House. Specialist training for councillors on scrutiny committees would be welcome. They could learn about, and hopefully understand, what they ought to be looking for. Please, may we have clear Government guidance on the use of the magical cover-up phrase "commercial confidentiality"? In Somerset, that phrase has been used time and again to explain away unnecessary secrecy. It is the motto of the county now. It has dropped whatever it used to be and it is now "Commercial confidentiality". It is used at every turn. Finally, a good deal is only as good as the cost and benefit realisation plan. We must have a mandatory standard.
	I am trying to be constructive for the future because I believe that, in Somerset at least, the project has been a complete disaster. Wool has been pulled over the eyes of the elected councillors and Alan Jones is clicking away with his knitting needles. I have been challenged to go and look at the contract. I have offered to take two forensic accountants, one business lawyer, Sir John Banham if he will come—I hope that he will—and possibly a couple of other people to help me. It will take six to seven days to go through it. However, I will not be allowed to see the whole contract or the whole business plan. I will not be allowed to see the correspondence on what made the deal possible and why the group was chosen over British Telecom and Capita. It is a joke. It is a sham. The group is hiding. Why?
	The unions have been ignored and a cover-up has been the order of the day. It is, I am afraid—I say this gently—no good for the Minister to say that this is a matter for the councils concerned. It has moved on from there. I am afraid that it is no good telling me any more that the district auditor is the person to go to. We have brought the matter up with the Minister and in business questions already.
	Somerset's crisis today is going to be someone else's tomorrow, without a shadow of a doubt. We need ministerial intervention, and I am afraid, to put it crudely, we need it pretty darn quick before the disaster gets worse.

Parmjit Dhanda: Not for the first time—for the second, I think—I am left somewhat breathless in a debate with the hon. Member for Bridgwater (Mr. Liddell-Grainger). He speaks with passion about the issue. If he carries on at this rate, the Parliament channel will be competing with the "The Apprentice" and other programmes for viewing figures.
	The hon. Gentleman is right about my response: it will be similar to the debate in March. I know that he is anticipating that in my comments about the role of the district auditor. If he has serious allegations to make about corruption, then he has made his views clear in no uncertain terms about the chief executive of Somerset county council and the chief constable of the constabulary. He did that in the previous Adjournment debate on 26 March and has used his parliamentary privilege to do so again today. As I said, the district auditor and the Serious Fraud Office are the places for him to go. He has indicated that that is what he intends to do.
	I congratulate the hon. Gentleman on securing this second debate on an issue that is fundamentally about Government PFI contracts. He has made it clear that he does not have a problem with PFI or with partnerships as a whole.
	I began my response to the debate in March with a warning, and I feel that I should do so again. It is important to recognise that although local authorities are increasingly strong and independent bodies, they are ultimately accountable to local residents, and must ensure that they act in a professional and responsible manner. Clearly there has been a breakdown in their relations with Members of Parliament—certainly with the hon. Member for Bridgwater—but ideally they should have a good rapport with MPs as well. I have run-ins with my own local authorities, for these things do not always run smoothly, but in an ideal world that would be the case.
	In particular, local authorities are responsible for the proper administration of their own financial records within the framework set by legislation—including the duty of best value and public procurement law—and codes of practice issued by professional bodies such as the Chartered Institute of Public Finance and Accountancy. For that reason, the specific questions raised by the hon. Gentleman can be answered directly only by Southwest One and by Somerset county council, Taunton Deane borough council and Avon and Somerset constabulary.
	As I have said, if the hon. Gentleman has specific evidence of financial irregularities or a failure to follow due process in the establishment of the Southwest One partnership, he should present it to the district auditor. I am well aware that he has already done that to some extent. The district auditor is the right person to investigate such matters. If the hon. Gentleman has more serious allegations of corruption, they should be presented to the Serious Fraud Office. I realise from what he has said tonight that he feels somewhat fettered, and does not feel able to speak to the local constabulary, because part of his issue is with them in the first place.
	Central Government cannot and, in my view, should not be involved in every action that councils take, and I think it right that neither Ministers nor officials have been involved in the development of the Southwest One partnership. However, owing to the hon. Gentleman's obvious concern about this project—not least that expressed in the debate in March—the Department has made inquiries of the Audit Commission and Somerset county council. I have to say that, so far, no evidence of wrongdoing has been presented to or uncovered by either the auditors or the police.
	Two auditors have been involved in reviewing the work to establish Southwest One. The Audit Commission appointed Grant Thornton to act as external auditor in 2006-07, and from 2007-08, the commission itself has acted as external auditor. Both auditors recently reported to Somerset county council, and I should say in fairness to them that they have been broadly positive about the processes that they followed. Grant Thornton summarised their opinions as follows:
	"Given the size and complexity of the contract, it is inevitable that there are some areas of the process where improvement could have been made, but overall our review found that arrangements were sufficiently robust to give us assurance."
	The Audit Commission has presented outline findings in similar terms, stating that there was a reasonable process for procurement with planned improved outcomes for the council, that there were appropriate reporting and staffing arrangements, and that the deal had been market-tested and improved through negotiation. The Audit Commission points out that considerable service and financial challenges remain—I know that the hon. Gentleman agrees with that—and the council needs to invest properly in the management of the contracts. In a project of this size, that is not surprising, but I hope that the partners in Southwest One will take on board the conclusions and redouble their efforts and prove this project a success.
	Both in this debate and when the hon. Gentleman spoke to me earlier this evening, he mentioned his concern about jobs; he fears that 5,000 jobs may be lost under some kind of redundancy scheme. However, in fairness to the hon. Gentleman—and also the local authority—he did make it clear that the county council has changed its position on that, and is now saying that any changes would be due to "natural wastage"; those are his words, not mine. Accountability for all these measures is ultimately through the ballot box at local level. Local authorities have to be able to demonstrate best value to their residents, but also, in an ideal world, work in partnership with local Members of Parliament.
	In broader terms on commissioning, procurement and shared services, central Government can—and do—facilitate the sharing of experience and expertise so that councils can make the most of the opportunities for more efficient and effective service delivery that are available through partnership with the private sector, the third sector, or other parts of the public sector. The hon. Gentleman was generous in his praise of the Government, and of the guidance and the work being done to support local authorities on that path.
	Many authorities are already benefiting from having entered partnerships: more than half of all councils say that they are engaged in, or are considering entering into, a service partnership, and that they expect to obtain savings of up to 15 per cent. as a result—savings not to be sniffed at. Let me cite as an example a partnership involving one local authority that covers customer services, revenue and benefits, property services, ICT and human resources. That has generated a variety of benefits, in this case including 12 per cent. cost savings on the services transferred, and improved service delivery such as better council tax and national non-domestic rate collection rates. Those are some of the advantages that can be gained through better partnership working.

Ian Liddell-Grainger: indicated assent.

Parmjit Dhanda: The hon. Gentleman agrees with that; he is nodding.
	I have heard what the hon. Gentleman has to say. I think the wider world has as well, not only through Westminster Hall, but also now through this Chamber. Let me reiterate what I said to the hon. Gentleman earlier. Failures of process are for the district auditor—
	 The motion having been made after Ten o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker  adjourned the House without Question put, pursuant to the Standing Order.
	 Adjourned at two minutes to Eleven o'clock.